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Attachment D <br />City of <br />. Copy lam, <br />Minnesota, USA <br />City of Roseville Cleanup Agreement <br />Residential Sanitary Sewer Backup Cleanup Assistance <br />THIS CLEANUP AGREEMENT, effective as of the dates of signatures below, is entered into by and <br />between the City of Roseville and , "Property <br />Owner", pursuant to the Residential Sanitary Sewer Backup Cleanup Assistance Policy. <br />GENERALIZED SCOPE OF SERVICE <br />Under the Residential Sanitary Sewer Backup Cleanup Assistance Policy, the City of Roseville agrees to assist <br />Property Owners in paying an approved contractor up to $5,000 per occurrence, per housing unit for services <br />mentioned below. Any costs exceeding $5,000 will be invoiced to the property owner. If the balance due is not <br />paid within 90 days, any remaining amount will be assessed to the property taxes. <br />Any payments will be made only in strict accordance with the Policy. In general, the City of Roseville will call an <br />authorized contractor to perform prompt cleanup assistance under the Residential Sanitary Sewer Backup <br />Cleanup Assistance Policy. The cleanup assistance is limited to wet extraction, sanitizing, deodorizing, removal <br />and disposal of damaged housing materials. The Property Owner is responsible for replacement of any damaged <br />property. The entire Policy will be available at www.cityofroseville.com. <br />REQUIRED INFORMATION <br />Property Owner's home address: <br />Property Owner's telephone number: <br />Service address (if different from Property Owner's home address): <br />Byway of signature below, the Property Owner certifies that he/she has read and understands the City of Roseville <br />Residential Sanitary Sewer Backup Cleanup Assistance Policy. The Property Owner hereby authorizes the City to <br />proceed with services as contained in said Policy. The Property Owner further understands and agrees that the <br />City in no way admits or accepts liability by entering into this Agreement or by offering the benefits of this Policy. <br />This Agreement is not intended, however, to prohibit or prevent pursuit of any other lawful remedies available to <br />Property Owner. <br />Date: <br />Date: <br />Property Owner: <br />Authorized City Representative: <br />Decline Assistance <br />I have been offered cleanup assistance as outlined in the City of Roseville's Sanitary Sewer Backup Cleanup <br />Assistance Policy. I decline to accept the cleanup assistance offered by the City. <br />Date: Property Owner: <br />