Walker �:L��.SV��'
: MA� 2 3 2012
NOTICE OF CLAIM FO of Saint Paul Minnesota
����t���' '
Minnesota State Statute 466.05 states that "...every person...who claims dmnages from arry municipality...shall cause to be presented to the
governing body of the municipality within 180 days a,�er the alleged loss or injury is discovered a notice stating the time,place,arul
circumstances thereof,a»d the amount of compensation or other relief demanderi"
Please complete this form in its entirety by clearly typing or printing your answer to each q.uestion. If more space is
needed,attach additional sheets. Please note that you wilt not be contacted by telephone to clarify answers,so provide as
much information as necessary to explain your claim,and the amount of compensation being requested. You will receive a
written acknowledgement once your form is received. The process can take up to ten weeks or longer depending on the
nature of your claim. This form must be signed,and both pages completed. If something does not apply,write`N/A'.
SEND COMPLETED FORM AND OTHER DOCUMENTS TO: CITY CLERK,
15 WEST KELLOGG BLVD, 310 CITY HALL, SAINT PAUL,MN 55102
First Name � () � �( Middle Initial � Last Name W � Z,.� L-. R
Company or Business Name
-----�re Yeu a��s�se�ex�pany�-�'es 1�-If Yes;Clai�Number? — , ��>��- - .",
Street Address y �� 7 �) r'C�1 �{►�o � � � r i V 2
City�yt i��, �P.c3.r ��:.�(Q, State�i h n�SO�c2 Zip Code .� � � � O
Daytime Phone(�)��b 9 Cell Phone(_� - Evening Telephone 6( �'1 )'�� -��G q
Date ofAccident/Injury or Date Discovered �1 a.re.� �, oZ0) � Timez�r'�"tr�0e�am pm
� �
Please state,in detail,what occurred(happened), and why you are submitting a claim.Please indicate why or how you
feel the City of Saint Paul ar its empioyees are involved and/or responsible for your damages, S 1:P a�� R a��o h� �
W0.�.tf ��r'V�IC�S G►1�W ✓�2.p�a`ZCQ .�. p�'6K�� 1Ma.�.tf� (vL3.tY� �fr�YNOhI e�'� ir�v �qov�p �
W��� IQ rLsr�l�rine� "'��Q � ole i����of„�'Y�ct� r��c�i����o � ih v� �he t-i�i l` e,�v���Y
-- .�.+ r' i� i � '}"�C 5t��t v i �w r b Zc:�v, e h W1 M fi e��h p�
o -C o"i' h�t 6 a. �m��'l a�� T C0.�(�p ^o I�oa_ �r �u al�'�
� e U rwi� � )Oh a � I5o l.c��� � r . OY � h reZv� ft ��r` q,
r w o- � -� ✓ �.i r �. v�i � . w i�r ; o te v�� .� 2�S(�Q,�
Please check the box(es)that most closely represent the reason for completing this form: - ,
❑My vehicle was damaged in an accident ❑ My vehicle was damaged during a tow
❑My vehicle was damaged by a pothole or condition of the street ❑My vehicle was damaged by a plow
_ ❑Mv vehicle was�rongfull towed and/or ticketed ❑ I was injured on City properiy
J�Other type of property damage-please speci �-�-���--c�--3-2 v+��-f�;h-���—
❑ Other type of injury-please specify �
In order to process your claim vou need to inelude coaies of all aanlicable doeuments.
For the claims types listed below,please be sure to include the documents indicated or it will delay the handling of
your claim. Documents WII,L NOT be returned and become the property of the City. You are encouraged to keep a
copy for yourself before submitting your claim form.
O Property da,mage claims to a vehicle:two estimates for the repairs to your vehicle if the damage exceeds
$500.00;or the actual bills and/or receipts for the repairs -
O Towing claims: legible copies of any ticket issued and a copy of tlie impound lot receipt
• Other property damage claims:two repair estimates if the damage exceeds$500.00;or the actual bills
and/or receipts for the repairs;deta.iled list of damaged items
O Injury claims: medical bills,receipts
, O Photographs are always welcome to document and support your claim but will not be retumed. •
Page 1 of 2-Please complete and return both pages of Claim Form
�
Failure to complete and return both pages will result in delay in the handling of your claim.
All Claims-please comulete this section .
Were there witnesses to the incident? •Yes No Unknown (circle)
Provide their names,addresses and telephone numbers: W ��"�� �.�p A'� � C r�e�/
Were the police or law enforcement called? Yes No Unknown (circle)
If yes,what department or agency? Case#or report#
Where did the accident or injury take place? Provide street address,cross street,intersection,name of par or facility,
closest landmazk,etc. Please be as detailed as possible. If necessary,atta.ch a diagram. 1'�(o c,,.cc� c�tv��a r- �_n��rr� .
S��''�� i h 'T'ror�� o�M�c �'►'�V he vr►Q • (
Please indicate the amount you are seeking in compensation or what you would like the City to do to resolve this claim
to your satisfaction. � 9 b S• �. � C�►�c.l� a., e.ol� o..-�` �'o y,.�.� �
Vehicle Claims-please complete this section ❑ check box if this section does not annlv
Your Vehicle: Year Make Model ��
License Plate Number Sta.te Color
Registered Owner
Driver of Vehicle
Area Damaged ,
City Vehicle: Year Make Model
License Plate Number State Color
Driver of Vehicle(City Employee's Name) �
• ' Area Damaged " ' ` �
Injurv Claims-please complete this section ❑check box if this seetion does not applv
How were you injured?
_ What part(s)of your body were injured? --
Have you sought medical treatment? Yes No Planning to Seek Treatment(circle)
When did you receive treatment? (provide-date(s))
Name of Medical Provider(s): -
Address Telephone
Did you miss work as a result of your injury? . Yes No
When did you miss work? (provide date(s))
Name of your Employer•
-—---Ad�s- -- - Telephone
j� Check here if you are attaching more pages to this claim form. Number of additional pages � .
By signing this form,you are stating that all information you have provided is true and correct to the best
of your knowledge. Unsigned jor»rs will not be processed
Submitting a false claim can result in prosecution. Date form was completed M 3'"�� .�� � �,b � �
Print the Name of the Person who Completed t ' Form: .� d h h e • W �. � k{n; .�r,
' Signature of Person Making the Claim: �. •
Revised February 2011 , ,
,
` � �� ^ i/ < � /1�
�O�O� Date �..� � // � Ticket No. �- r�Lf?��
ROOTERo P� Custome� ��✓1 e���r Technician ,..%'�,�
�':"-i '.�:?:o`f`:7i��'�'i�.;`_ !n{tert ,.n�a
PLUMBING 8 . _. i r��_ '4 '.� —
, DRAIN SERVICE � . _ — �!s.Kg i ��i,,•:��4f` . .' �i�Y. � .
1 -800-GET-ROTO _ ;��� �_��:=��._ ... -:a
R@Sld@rltial Sit@ IIISp@Ct1011 8� EStlmat@ (See Binding Terms On Reverse)
Customer
Qt /Location/Descri tion Labor Parts Discount Total Accept Decline
Sink-F�ttcet�W�#�r S�plie�; CJ p
Si�tk-[k�in l�es � ���� l �� � �❑ � ;
� �rigera#or-Icce Maker � � �� ������ � �
r
� p�spt�wr p� � �`� �!��r������ � �I
[7ishwa��er�itV�Harr�er} � ` ��p. Q �
.�
1+�#e�Fi�ter � C�� � �;�a,� � �� ��� � �E,� C! �
, Lav-Faucet&Water Supplies ❑ � . ❑ ❑ �
E Lavatory-Drain Lines ❑ L`�� ❑ ❑
� Shower �/ �T—
L � �
mToilet-0 eration �
Drainage p `� r��� � ��— ❑
� .�, » � � - ,.
���.�: ,,���� � � �� �� .�� �, �������.,�.P.- ;„��.F _ _��� . � �� �� a_
, � � , � . _ e ,
� Washer Drains 0 �'1_� p [p :
�' Washing Machine Hoses D : p ,p
�d�et�mmer Arrester �j� [�
Relie#�%alves` ��, ` �� ❑
w; Tankless(Water temperature) ! � ❑
= Tank %❑ � :❑ p
d Boiler Drain ❑ ❑ ❑
� Ball Valve/Shut-Offs , ❑ ❑
Water Supply&Piping � ❑
V�ater#��i'pirr� ' ��� '� . � : ' C7
�
e
, ,
� � .
_�. , � �
� Shut-tt�f at Water SeNice p
=�� [�rain�ines � ❑
�
P� in U �
� �� � .
=r �e�te�u� ue Q.
� � � . � e.. ���
9 . ��.,.. , e�I
�ater€�S+�rage cm Fl�r C� �l p
' o Main Sewer Line ❑ ❑ ❑
wl Hose Bib ❑ ❑ ❑
W Downspouts ❑ ❑ ❑
< �irt#��rrt���'ro�t��t���� �� �� � , ; , 4,. .,� �Ct �����
r ,e
` 1`� Ct = �� ���� _ ��� � �
, _
� m I. ,' ; ���
� � ��new �,�� �3 r a ; : ��������,� . ���—� �.,;���� �_��� �
4ther �. -�� .g��� �e� � �� - p p
�_
WORK ORDER AU ORIZATION I authori�e the services indicated above and agree to pay the amounts specified. I have
read an agr to th rms on the revers si ncludin th limits on Roto-Rooter's r s ons`bility specified•in{hose terms. � � '- �`� ��9
LZC "__ `�.
(Signature (Print Name) J o n G . c�� }'�a� � �
�
ESTIMA E A ESCRIPTIO F WOR TO BE PE D: ,� , �' l Total estimate reflects customer
d��7- �'" r> , y�' „� ,,� � yt PfCT � authorization of work as indicated above.
r � � �` �� � Labor $ / , �O
l ° � f!^-•._S - Parts $ �..7•�
'�- - c� /�t2✓�, Discount $
COM ENTSIA JUSTMENTSICHANGES IN WO K:
Product $
� G��p/ - �,.�� 1'�i G� !/�' ,.� % . �� S .�, '�O
' TOTAL $ �as �1
Tax not included in estimate.
COMPLETI , I ckn�wled ompl�tion of th abo�d scrib�d work which has been do my cor�plete satisfaction. ` +
(Signature) �-� , V� �.�� � 1. y (Print Name) J �� y� ��� L. . �� i � r ; .j �. �
— _ _ �l CUSTOMER COPY �'
Roto-Rooter Services Company
Terms and Conditions
The following terms apply to all work performed by Roto-Rooter Services Company or its affiliates("us")for the customer indicated on
the front of this form("you").
1. Your Responsibilities. You agree to(a)remove any hazards,obstructions or dangerous conditions azound the job site not caused by
our work,(b)limit access to the job site so that people not working on our job aze not exposed to dangerous conditions relating to our job,(c)
place appropriate warnings to warn of dangerous conditions when we are not on the job site,and(d)provide us with adequate access.
2. Exceptions to Our Responsibilities. We are not responsible for(a)personal injury,property damage or other damage or loss to you
' or others arising out of our work,except to the extent caused by our negligence ar failure to perform the work in accordance with the contract
' between us;(b)defective,damaged,or deteriorated lines,mold,lead piping,or other unexpected or undisclosed conditions,and the consequences
of such conditions,including delays,broken fixtures or lines,and lodged equipment(if we encounter such a condition,we may stop work,and
you will pay us a reasonable charge for the work performed;(c)the time required to complete our work with reasonable diligence;(d)unless
explicitly stated in writing,any damage necessary to complete our work,including damage to landscaping,walls,painting,tile or concrete or
� similar items;(e)damage caused by the removal of any clean out,drain cover or cap;or(�tasks we perform in accordance with your specific
instructions.
i3.Release and Hold Harmless. You release us from(and if you are a commercial customer,you will defend and indemnify us and hold
us harmless against)all damages,claims,demands,setflements,judgments,liabilities,costs and expenses,including reasonable attorneys'fees,
; a11egedly arising out of(a)breach of your responsibilities under paragraph 1,or(b)matters for which we disclaim responsibility under
paragraph 2.
4. Our Guarantee. If we provide a parts or equipment guarantee,as your exclusive remedy,we will give you the benefit we receive,if
any,under the manufacturer's warranty. If we provide a service guarantee,it covers only drainage failure in the line serviced,and defective
plumbing workmanship,during the guarantee term. As your exclusive remedy under our service guarantee,we will,at our option,either do the
work again at no labor cost or refund your payment.Guarantees do not apply to problems arising out of main sewer line backup or improper,
abnormal or unanticipated use or conditions. Except as explicitly stated in writing,we are not giving any guarantees or making any warranties.
WE DISCLAIM ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. You may
transfer a guarantee of plumbing repair or replacement to a person who purchases the property,but you may not transfer a drain cleaning or
toilet auger guarantee.Your transferee must present the warranty claim to Roto-Rooter at the time we perform our work.We do not guarantee
' that our site inspection will identify all existing or potential problems.Any damages or necessary repairs arising from plumbing problems,
either identified or unidentified,are the sole responsibility of the customer.
5. Limitation of Damages.Our liability to you for any claim arising out of our work on any job(other than a claim permitted by these
terms far personal or bodily injury)will in no event exceed three times the amount you actually pay us for the work on that job.EXCEPT FOR A
CLAIM PERMITTED BY THESE TERMS FOR PERSONAL OR BODILY INJURY OR PROPERTY DAMAGE,YOU WAIVE ANY RIGHT
TO RECOVER INCIDENTAL DAMAGES,CONSEQUENTIAL DAMAGES,OR DELAY DAMAGES.
6. Pa�ment Terms.When you provide a check as payment,you authorize us either to use information from your check to make a
one-time electronic fund transfer from your account or to process the payment as a check transaction. If you fail to pay us any amount when due,
we will charge you interest on the amount due at the rate of 1.5%per month(but not exceeding the highest rate legally pemussible). You will
reimburse us.for the reasonable attorneys'fees we incur in all stages of collection. = �--
� 7. General. These terms are part of our contractual agreement and will prevaii over any inconsistent terms in any other agreement
between us,including the terms of any purchase order,and may be modified only in a written instrument signed by both of us which specifically
' refers to the provisions to be modified. If any of these terms is held invalid or unenforceable,the remaining provisions will not be affected and
will continue to apply.
HOW TO RESOLVE A PROBLEM
• Contact the manager at your Roto-Rooter off'ice. Everything will be done to resolve your
problem at the localleveL
. If your problem cannot be resolved locally,please contact Pat Swanson,Customer Service
Coordinator,in our national headquarters:
Pat Swanson or email�swanson@nsc.com
Roto-Rooter Services Company
2500 Chemed Center
255 East Fifth Street
Cincinnati,OH 45202
ROTO— VIDEO INSPECTION OF
ROOTER� SEWER LINE AND RECOMMENDED �ate ,s
PwMSiNC g SERVICE OR REPAIR Ticket No. �f
OIIAIN SERYICE ��� �/d�'7
F�3t0-RC)G1tGP�'S^�SCf�C;QI(:Gl��ty
�fl�zt;'i l�.b�.�� !ti.'u'4'.,Sfe.�'�t�,;�i�:'.�'.%,eHf tt..�;`i�'<<�551";�
�rtlic� 8�AG3;-�;�f�C3�'"�(4;ii;-i�t'.i�i��E:�r;;:�S:i�)638-9�9ir
h&uyn��;ata�.frerES���'c�5�^�Or��1
� +
I /
t j �
Customer ��'�l`'?1"�! l;'„1�;'� '� jG 7 -� ,
� Address l�� ` '�/l{�ij �,y / , , j
�J r�' � r'i�i/ �� �i i�—�� ��.
fr` ���1 .��, '�
Roto-Rooter has conducted a video inspection of your sewer line,which shows one or more of the following problems: �
� REVIEW ,
i
Complete Collapse-The pipe has collapsed and cannot be cleaned or opened through mechanical methods. i
� Broken, Cracked or Corroded-The pipe has deteriorated and/or broken, causing partial collapse(s)in the line and I
restricting flow.
❑ Bellied Pi e-A section of i e has sunk due to round or soil conditions,creatin a valle or di �n the i e that I
P P�P 9 9 Y p� P P I
restricts flow and collects paper and waste.
� Leaking Joints-The seals between pipes have broken, disconnected or corroded, allowing waste water to escape I
�
into the areas surrounding the pipe.
� Blockages-Grease buildup or a foreign object is restricting or prohibiting proper flow and/or pertormance of the line.
� Punctured Pipe-A foreign object has perforated the sewer line.
� Root Infiltration-Tree or shrub roots have invaded the sewer line.
SOLUTION
Customer Initials Cable or Jet Sewer Line-Roto-Rooter will clean the line either with a mechanical blade and cable or a high-pressure
water jet. PLEASE NOTE: This is a temporary solution and will not address the underlying problem with the pipe.
There is high likelihood that the line will back up again in the future.When that will happen cannot be determined at
this time.
r Spot Repair-Roto-Rooter will repair or replace a section of the sewer line. We will jet clean and video the remainder
' of the line. If we discover problems in other parts of the line during this work,we will notify you, and at your request,
� .�
�= provide a proposal and cost estimate for any additional required work.
Full Line Replacement-Roto-Rooter will replace the sewer line between finro(2)agreed-upon points using one of the
following methods:
� Open Trench-The existing line will be excavated, removed and replaced with new pipe and clean-out. The I
trench will be backfilled above grade to allow for settling.
� Pipe Lining(if permitted by local authority)-A new pipe sleeve will be installed inside the problem line.
Minimal excavation may be required for this method.
� Pipe Bursting(if permitted by local authority)-A new pipe will be pulled through the existing pipe. Some
excavation may be necessary for this method.
Comments:
--
�i�'�.�'i'�'�-'�- �� f �
� i'. ' ','FL� �� J`��o�
nic' n Signatur�— T' �rinted Name/Technician Number Dat
I have di�c�ssed all solution:c�p}pa,�s with Roto-Rooter. 1 have initialed the solution I prefer above for addressing this problem.
�`Yih.. �, .�r��,f c:_ � ��. a.� �.j .. �'� t\ �r . �...,`I� .,.. 1 ' � !� J • /✓1 -:r L ��+ ��� <_'-
� ! � Pnnted Name °ate
Cust er Signature -
SL-INSP-IMPRINT (Rev 5111)
CUSTOMER COPY : �
jfi' _ _ ,_,- ... . . . . I
ROTOSAVE THIS INVOICE FOR YOUR GUARANTEE DATEOFSERVICE �ocaT�or,
� SEE BINDING TERMS ON REVERSE �D (% ST. PAUL
ROOTER� RotaFir,�ter Services Gomp�ny �`1�`� _
;7 � .
R���'�A'����• SERVICE TECHNICIAN'S NAME ��a'=���---�—� � �.
P L U M B 1 N G !ti 5672 Goilections Center E)rive • •
DRAIN SERYICE Chicago IL 6�93 �� � �,>- r � j � ��r
1 -800-GET-ROTO �""�,�G�-����-7�
Ger�ral{65?)63�-�
M����,��pM SEWER&DRAIN� PLUMBING❑ PUMPING❑
(438-7GSG� INDUSTRIAL❑ EXCAVATION❑ DRAINTILE❑
CUSTOMER NAME CUSTOMER NO. CUS7oMER CI.ASS
,Y"
j�j�,a; ;,._��', �1���<;".� RESIDENTIAL � COMMERCIAL ,
BILLING ADDRESS t J,��. ,.1 .� _��^ APT.NUMBER FEDERAL I.D.# �/y�
!� % 1>; ;rs'( �'� rsc�+; �i(L 4`�"�aa�7Va/ I
CITY / � STATE/PROVINCE ZIP/POSTAL CUSTOMER PHONE NO. P.O.NUMBER/AUTHORIZATION '
�/f/�l,i ; �Z� �i:�°.C.-,,. L f`� /:'!:�� � .S / ! C.i -_�t_,..�i? ...��;r'��� 'I
SERVICE ADDRESS(IF DIFFERENT THAN BILLING ADDRESS) CITY STATE/PROVINCE ZIP/POSTAL '
WORK ORDER AUTHORIZATION I authorize the services indicated and agree to pay the amounts specified.I have read and agree to the terms on the reverse side,including the
limits on Roto-Rooter's responsil�ility specified in those terms.
, t
� � � � `� ' . ! _; l � ' � +
SIGNATUR ` ,.' . ?:� � .. v )� d %�.-..f's, �1," PRINT NAM `K.. ..: "� ,, t.. �,��,- ;S i ���� �' ; �: !'
REPAIR CODE IMATE AND DESCRIPTION OF WORK TO B��RFORMED (The approximate starting date is ,and the approximate completion date
is .Neither dffie is guaranteed.Unexpected conditions or problems could cause delays.A definite completion date is not of the essence.)
��L(C'f 4"w�-��,:u' ^�."' i"Lrt� f� :?� " ;,2 ' �.l -'��r �'�� �� � $AMOUNT
! , ;:. ,'t _ _ ;f . �t � - ,. -i � _� '
-_. . . . , , ,.
, , ,, . �
, _ ; / ,
' _ � �C t .,- � .- ..�_ �r �.(�..`�. g__ ..r i �r,�' �./r" i- ;G. -:i
F
/t •
� -..�'�t'�-v� r')— �'l,j y .y� j e; � !`'' �Y`.-<�f Cv ��` �:� '�� i
ADJUSTMENTS/CHANGES IN WORK TO BE PERFORMED (Use additional invoice if needed to describe changes) �'
RESIDENTIAL GUARANTEE COMMERCIAL GUARANTEE {
PAYMENT
LABOR LABOR LABOR$ ` �'�- �=-=~% '
�Main/Branch Lines 6 months �Main/Branch Lines 30 days ❑CASH �CHECK NO.
�Toilet Auger 7 days �Toilet Auger 24 hours CREDIT CARD NO. PARTS$
�Plumbing Repair 6 months ❑Plumbing Repair 90 days PRODUCTS$ '
❑Plumbing Replacement 1 year ❑Plumbing Rep�acement 90 days � NET 10 DAYS AUTH# OTHER$ ,
Extended Guarantee � ear OVER 30 DAYS= LATE CHARGE OF 1 1/2% PER MONTH �
y r '" � " �� ' 'In the event check is retumed, the COMPANY will charge TAX$ ,
REASON FOR NO GUARANTEE the CUSTOMER a$25.00 processing fee. ��.
INVOICE TOTAL$ �G �. ��)
COMPLETION I acknowledge completion of the above described work which has been done to my complete satisfaction.
(SIGNATUR� (PRINT NAME�
__ __ _ _ _ __ _`-.� Send plumbing iips,ProducUservices �
E-MAILADDRESSL -------__:-- ---: ---------------------------- ---__ ____ infor�ti2n�ancL�ouP9nsvsl�m�il�_�-.
� NEXT TIME TIME TIME
VISIT DISPATCHED ARRIVED DONE • •
IRR LOCATION �,p� �Q�g INVOICE DATE � � ��
SUGGESTIONS FOR REPAIR/REPLACEMENT FROM O/S OR TRUCK �/ PARTS USAGE
ITEM LOCATION ESTIMATED YOU SAVE QTY T/ TOTAL SELL
COST TODAY VENDOR PART# USED OS DESCRIPTION COST PRICE
WATER HEATER
DISPOSER
- SINK '
TOILET
BATHTUB
SHOWER
FAUCEf
DRAIN
OTHER
TOTALS—�
(Service Technician's Signature)
(CLERK'S SIGNATUR�
�� BILLING COPY/INVENTORY COPY
-----__
Rz�to-Roote��Sei-vices Company
Terms and Conditions
The fu".,:� �n� te_rm.>a2�;?'�� t�� a11 �vork. p�ri�ormed by Roto-Ro��ter Services Comrany or it,af(iliates("us")far the customer indicated��1:
the front of this form ;;"you").
1. Your Res�onsibilities. You <t<,ree:o;��)rr�nove any hazards,obstructioi:�5�_���c.«<�i��er��us condi±ion� around the job site :�ot�<zu.�e:a b}�
our work.(b) liinit access to the joh sitc sv t��ai pecple nu! workii�g o:?our jr�i��u-e i�ol �°xpose;l i:��i,i��"er-c�u.� conditions relating to our job,;cj
�iac� <�I�pr�;priate ��;�arning�to��arn uf darger��u; �onditions �vhen �ee �ire r,�t:�n ?he jor; �itc.ai�d{d) p��••,��iL�ts �vilh ad?qu<tte access.
� 3_,X�? �irlpi Cl�(�ll� <c:S�7 }CiS3�i�Il.leti. Ul�e 8i_'Il(1!IL'SOOtlSibl� fi�f��il �C'1:;Ot111�. liilUC��,�tO�L�:�� rj�,ll;'<1�C �1�'JIIIf;I(�c11:12t6e OI'IOtiS�'.) ��pl!
or others arisin�out of uu� �tif�.k..et�,1Jt tc�tl�e extent cau�e�' by our negli�e�.�e or failure io perfnr�n thr-�,vork in �.ccordan�e with the cc;nti-act
f%�,I�CL❑ fi5; ��, ttt{��_.l��-t, ' ; L::1�C('_t>i�C�t'iC;`lUt'al2i� ��iiCS._Iluiu,:C'a� �71piI!�.0�lil�lt'I ill?�a(Jt:Cltt�a)_ �1:7G 3C!JS�;�Cl?ildlt10R5,al]C� Tl7e.COTiSZC]U:IiCk'S
(1!'�i7C�1 C011ljl,ltl(1S.I(1C�U<�ll�O )� ,=. .. hfC��:L_ f„ittt:,�c ;�t l:P ` <`:1u 10(j°CC� "l:)�l'.�ctlC �� ;4_� t`17::r)�111tC?'S�lC�? :i':OI7�]tlOh,VJe Tllay'StO�WOCIC.�311C�
yi)l; N'lii I���V U� 21 i'�J�iti�)I«i�'�� � �:_:iC. i(i!r�iC �Vpt'it i)��-�(lf'[�7C�i}, (�'�[jlf li1P,C .�(�.�.J'i=U il)�t_'r71l�11�:°i;:?�ti��;!1i�_ AVl��?IC;1SU1]Abit'(�I�1�eilCC; �Q� UII1t'.SS
eX�J�iClt�� Stdt��C� li� A`,'TIYIT;C3, i�?`-�Lal�l��� !t-'_L�SS�1Cy'YG C(lill��CTe nUi�VOI�t�,li1C�!i�Lli�'(jti;illve rD�;iI70�SCC3�1Tlt;,AVii1�S,�);1lTltlllb,fl�e OI COIIC.CIe G`I'
SIiIlll2iC ittli�.�, ', 1 C�£ 11:1�Z�C:jU�C� i?�� lF1'.' C�I7�0A'�11 � �•�`�. .i_ . . =.)'.��..tjl�alil �v'.CI:`.� �_!�?: i_.l� �? :<iS�S',A'C �C.f;.111_i,' I;;��)::�=t�1_<'Wlt}1 yOUI S�JCC!fiC
ti]StI'LlCIIpIIS.
J,tZC�C�t�c �lii� �iC��� �1�_��'1111i'�;�. `1 UL!F�C'L�:lS� U� �1-:�ilf �al'lij 1FyUU dl'C G� COI1llI1ZCG1�ll OUStOIIleT',�'OLI W11� �PfC'•1Cj �l(]('�L"l:iCi77IIli�US nll�ii�)�:_':
us harmless againstl all dai lagc�_claims,demands,sstt!cr�ei�?_, �udbinci�ts,liabili'.:�.cc.�t.; ,r7�+.�������nses,includinb reasonabic attc,rneys' fees.
allegedly arising out of(a)breach of your responsibilities under paraaraph ],or(b)matters for which we disclaim responsibility under
paraRr-�pl� ?.
4. Our Guarantee. Ifi we provide a parts ur equipn�ent g�Earantee.as your exclusive re��ledy,:ve.�+�ill give you the ber�eYit�ve receiee..if
dny,uflej?t'trle rl',2l17LIf�I�tU[r•;'ti lNNr,�trliti� �i�We (,I',��E�:jC Fl ScI viCC �,U21r�1t7tC•t-, 1!i'Clt�er��l)I1�5% .�rc!}17�1L�i�iilUr� lt�ti)P. lr[,2 �S�f-\iC?d,dnc�def�lC!"'.
_ ... �.� _ .i. ; . , . . . . .
iii�iL��.;..b -�_:l_i_i�.;ioi.ij�,:ivaili'b'illl:bllili.aIil�:l;ICLI:i. .�S�vl.i d�.;iUJi�C it;liicGy U11Udi UUi ��1V1LG b'UulallleC,N'C Wlll,Al OUI O(Jf10II�81t�'leS C10 tllC
work again at no labor cost or refund your paymeni. Cuarantees do not apply to problems arisin�*oui��f main sewer line backup or improper,
abnormal�rr un�in�icipated use or conditions. Fxcept as explicitly stated in wr�iting,�t�e a�e not�ivin�any guxrantees or making a�y �varranties.
WE DISCLAIM A�\Y iMPLI`c,D WARI�ANTiES �JF'�9GRCHANT�.BILIT�' OR F1T:VESS FOR A PARTICULAR PURPOSE. Yc�u �;�ay�
transfer a�u��r�mtee of piu:�lbing �c��;air or repl�icement io a person �vho purchase, th� property,but yoa ma}� not tiar�sfer a eirain cleanii�g u��
toi[et au�e�r gua�antee. `r'our tr�ulsi�eree must p�e��nt [he ���arranty claim to Roto-Rooter a�the time we periorm our�F�ork.
5, Lin�itation of Dn;n�i��cs_Oiir iiabilit� ��_�yvu lor an_y clai�r ar;sing out of our��vork ozi any job(o*her thail a clai2n permitted by thesc
terms for persona; ��r bodily inju��;i wil� ii� r�c��ver�.exceed ,h�e�tirnes the aruc�unt vo« artually pay us for the ���ork on thai ior. EXCEPT t�OR A
CLAIM PERMI'I"I'ED SY THE,���TER�1`� FOR YERSONAL OR BODILY INJURY C�i'RUP�RTY D��MAGE,YOli W�IVE ANY RIGH:'
TO R�COi'ER TNCIL�L,tiTAL DAN�AGES,CO'VSEQUENTIAL DAMAGES,OR DFL.A"r� t��AMAGES.
6. Pavn�c±�!"i�cir,���.�i�lr�<< ��,�: provi�_ie a chc.:k as paym��nt,����u authorize us iill:e; [u u;� inft�n��a[i�,r�fron�� your�:lieck lo tnakc a
�.�rie-1llllt' CICt ill�.]fC Uil<i Ll:,"�i�'� {�.�i 1t y;�ll?'1'.C�'(�Unl OC IO�1'OCe55 1�1�� 1�1V�11i°:�i <L d��hcCi� ll'8i]5,iCt101], �i Yi�tl f�il� l0�21V US dTly d1riOLlIlC W�lell<�UU,
:4'� \n.i� Clidl-�Tl'j�Oli �!l1c7('(°Sf. �a.-� �:�ii.;�11I�OUIIi liur'�ill til2 f�i��Oi�.��- �)�d'Illlllli�l i+;ll� FlOC�X�tc(�111!?1�1�Il{�'ilC.;f :£liC� iC�:�liy pC'1'I111S>"tll�C�:. ' , �
�i�t! ��,tl.
1'elipbU'�ti� I�IS I(1G'lit' i�.'1i�0t11h�C �ittOl�lley> 1�C�9:; ��'t' II7C,(1� !ti ?l� Si:i�,�ti l'•� CO�lC:;11:?fl.
7. GeneraL The�e terrn����e p�u i,��u�r contra�tual agreemen�and rrii� prevail �iver any inconsisteni icn.1:> in any orher abreement
. . .�� . .
hPfWP!II US.1nCl�iriiTl�r th�tPr-*p': ^f^ i . .. .. ., '-�� .�, . .,_.. .. . � .,., , , � , �. . � � _
_ . _ a _. �:�u'.�_�i,, il tiiblled by bOi��t�i L�° �'Eit:_i; ����.ti��u._
reieis�n tl�e pi�r,��i�ion�::�'���.��uJit7ed.-If any offhese fe�rm�isl�elc�,�;��,ilid or i�r,e:ifi�rceab�e;��remaCni7� r����visions�vin;�of1�e�i?�ecfiecl-�an7�-�
will continue±o appl}'.
HOW TO RL+'SOI,VE a PROBLEI�1
�
+ C':>>�tact tiie mai�a��er at yot�r Roto-Rooter office. Ever}�thin� �,,�ill h�.� �Jone tu res;��l��e���u��
� �:r:;;c.it al tii.;iuCai ic��i.
� • Ii v��ur prohlem cannot be resolved locally,plea�e contac�Pat S���anson.Customer Service
Cuorclinator,in our n�itional headyuarters:
Roto-Rooter Services C��mpany or email pswansonC�rrsc.com
2500 Chemed Center
255 East Fitth Street
Cincinnati,OH 45202