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Citvof Attachment 3 Y1* �/ Minnesota, USA City of Roseville Cleanup Agreement Residential Sanitary Sewer Backup Cleanup Assistance THIS CLEANUP AGREEMENT, effective as of the dates of signatures below, is entered into by and between the City of Roseville and , "Property Owner", pursuant to the Residential Sanitary Sewer Backup Cleanup Assistance Policy. GENERALIZED SCOPE OF SERVICE Under the Residential Sanitary Sewer Backup Cleanup Assistance Policy, the City of Roseville agrees to assist Property Owners in paying an approved contractor up to $7,500 per occurrence, per housing unit for services mentioned below. Any costs exceeding $7,500 will be invoiced to the property owner. If the balance due is not paid within 90 days, any remaining amount will be assessed to the property taxes. Any payments will be made only in strict accordance with the Policy. In general, the City of Roseville will call an authorized contractor to perform prompt cleanup assistance under the Residential Sanitary Sewer Backup Cleanup Assistance Policy. The cleanup assistance is limited to wet extraction, sanitizing, deodorizing, removal and disposal of damaged housing materials. The Property Owner is responsible for replacement of any damaged property. The entire Policy will be available at www.cityofroseville.com. REQUIRED INFORMATION Property Owner's home address: Property Owner's telephone number: Service address (if different from Property Owner's home address): By signing below, the Property Owner certifies that the Property Owner has read and understands the City of Roseville Residential Sanitary Sewer Backup Cleanup Assistance Policy. The Property Owner hereby authorizes the City to proceed with services as contained in said Policy. The Property Ownerfurther understands and agrees that the City in no way admits or accepts liability by entering into this Agreement or by offering the benefits of this Policy. This Agreement is not intended, however, to prohibit or prevent pursuit of any other lawful remedies available to Property Owner. Date: Property Owner: Date: Authorized City Representative: Decline Assistance I have been offered cleanup assistance as outlined in the City of Roseville's Sanitary Sewer Backup Cleanup Assistance Policy. I decline to accept the cleanup assistance offered by the City. Date: Property Owner: