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3. Goodwill Sewer and Water PolicyCity of Kalispell Public Works Department Post Office Box 1997, Kalispell, Montana 59903-1997 -Telephone (406)758-7720, Fax (406)758-7831 REPORT TO: Mayor and City Council FROM: James C. Hansz, P.E., Director of Public SUBJECT: Review and Consider Possible Water/ MEETING DATE: Work Session December 11, 2006 Every so often there is a blockage in one of the City sewer mains. In most cases the blockage is quickly cleared by City maintenance crews and there is no lingering problem.. However, there are times when maintenance crews are unable to clear the block in time to prevent sewage from backing up in the main and into a house or business. On less frequent occasions a City water line problem might cause similar flooding into a basement or crawl space. Water and sewer back-ups do not happen often, but when they do it can be a serious problem for the customer. The City's sewer and water systems are very well maintained. As a result, claims by customers for damage reimbursement or cleaning costs are routinely denied by the City's insurance carrier, MMIA. No policy mechanism currently exists for the City to deal with these situations in any other way. Several months ago, the City Council asked PWD staff to research options for dealing with losses to City utility customers due to problems with the City's main lines. Terri Loudermilk prepared the attached report which outlines the ways other Montana cities have addressed this issue in their communities. December 11, 2006 Water -Sewer Goodwill Poticy.doc ::::::::.-. :,��:.:: ............... . . . . .............. . ........ ..... ....... ........... ..... .. . . . . .... .. .. . ... . . ...... . ...... . ....... ....... . . . ....... .... .................. ................ . . .. ......... ... .. . ... .. ... . . ... ... City of Kalispell Public Works Department ..................................... ..... .. .. ... .. .. ... ...... . . . . . ................... . ........................... ........ . .. ............ .... . ... .. . . ........ . .. .. ... :_:__­__­ . . . ...... .... ... . ... ... .. ...... ,r . . . . .. ...... .... ..... ... ... .... ..... . . . . ...... --- .... ... ..... .. . ... .... .... . . . ......... . ... . ......... .. . ... . . ............... .. ..... . . .. . ................ °��..... .. . � � � � `�''" °� post Ot�ice Box 1997, Kalispell, Montana 59903-1997 -Telephone (406)758-7720, Fax (406)758-7831 I�pl��fl'��I�19�i V' III � MEMORANDUM Date: November 27, 2006 To: Jirn Hansz, public Works Director From: Terri Loudermilk, Budget Resource Manager ` Re: Water/Sewer Goodwill Policy In response to the City Council's question as to whether or not other Montana communities offer compensation to residents or businesses that have experienced property damage caused from a City water or sewer main incident, I researched and assembled the following information. Current City folic Whenever a home owner or business experiences property damage due to a sewer main backup or grater main brew, the affected party submits a claim to the City's insurance carrier (MMIA). MMIA conducts an investigation of the incident. If the incident was caused by an Act of God, such as extreme weather, or by a third party, such as a contractor damaging the City's main, the City is generally found not liable and the claim is denied. Also, because the City has a well documented utility maintenance program in place the claim will most likely be denied. In all recent cases this has been MMIA's decision. There are approximately 2 to 5 cases each year and most are related to sewer back-ups. Homeowner's Insurance Water and sewer backups are excluded on standard homeowner's policies. An endorsement must be separately purchased that covers water and severer backups. Most policies and endorsements are subjected to a $1,000 deductible. Most homeowners are not aware that they are not covered for these types of incidents. In order to be covered they must purchase an additional endorsement. A local insurance company stated that adding a 'water and Sewer backup endorsement with a $1,000 deductible adds approximately $60.00 to a standard policy. It is an endorsement they automatically apply to any policy they write. The company I spore with did not know if other insurance companies followed the same procedure. Other Montana Cities The City of Whitefish recently adopted a Goodwill policy that recommends a maximum of $51,000 per claim and anticipates 2 to 4 claims per year. The City Manager may authorize payments over $5,000. Annual funding comes from the water &. Wastewater Fund. All claims are initially sent to MMIA for payment or denial of payment. A committee consisting of the Public Works Director, Public Works Utility Supervisor, and Finance Director review claims Water sewer Goodwill Policy Memo (2).doc following the City's established policy guidelines. Whitefish's policy guidelines state that compensation may be denied or limited, particularly in cases involving third party liability or "`Acts of God". The claimant must sign a waiver releasing the City from any further claim or action. If the damage is only for cleaning costs the maximum reimbursement is $11000. The City of Billings has had a Goodwill Policy in place for many years. The policy covers only sewer backups. Claims are reviewed by the Distribution & Collection Superintendent and are limited to a maximum of $11,000. The annual budget is $12,5 00 in the sanitary sewer fund. The City of Great Falls Goodwill Policy is similar to Whitefish and Billings. The difference is Cheat Falls' policy guidelines specifically state that claims will not be paid in cases of "Acts of God" or clear liability on a third party. Also, Great Falls does not have a $1,000 limit on cleanup. The funds come directly out of the water and sanitary sewer funds. The annual budget for water is $12,000 and $15,000 in sewer. Very seldom is a water claim received. They receive approximately 10 sewer claims each year. The City of Missoula has a goodwill policy in place for sewer main backups. Missoula's Goodwill Policy will compensate for damage after MMIA has determined that the city is not liable. Missoula has a step program in place. For example, if the amount requested is less than $2M00 the Public Works Director may approve it. Up to $5,000 the City Administrator approves the claim and for claims over $5,000 the City Council must approve. The funds come directly out of the Sanitary Sewer fund. The annual budget is $70,000. The City of Helena does not have a Goodwill Policy. The City of Bozeman —received no response. City of Columbia Falls does not have a Goodwill Policy. Similar Characteristics The Cities with established Goodwill Policies included the following attributes in their programs: • Goodwill Policy reimbursement is not an option until after MMIA has concluded its investigation. • A board or individual is appointed to review claims. * The reviewer follows written guidelines. * A maximum payout amount is usually established. • Individuals must sign a waiver releasing the City from any further claims or action. • Funding comes from the water & Sanitary Sewer funds. It is important to remember that a Goodwill Policy is only for damage caused from a City utility i.e., water or sewer main), and not for damage that may have been caused from problems with an individual's private service line. Water Sewer Goodwill Policy Memo (2).doe NUVIIA Recommendation Bob Worthington, MMIA CEO recommends Kalispell implem_cnt a Goodwill Policy. From an insurance standpoint MMIA doesn't believe that it opens the City up to further liability. In fact, there is the possibility that it could alleviate further challenges or lawsuits against the City. However, it is very important that the City wait to reimburse an expense until after MMIA has concluded its investigation of a claim. The cities that have Goodwill policies have had minimal payouts, and from a public relations standpoint the feedback has been very positive. Fundin a Goodwill. Pro m Possible funding options: 1. Add a surcharge to the bi-monthly utility bill, similar to the existing meter replacement fee. For example, adding a $0.25 charge to the bi-monthly water bill would generate approximately $11,000 in revenue annually to fund damage reimbursements due to water amain breaks; adding a similar charge to the sewer bill also generates approximately $11,000 annually for sewer back-ups. 2. Increase the rate per 1,000 gallons: adding $0.01 to the rate for every 1,000 gallons of use would generate approximately $7,500 for each fund. 3. Place no surcharges on the utility bill; fund the program from current rates. Set aside an annually budgeted amount each fiscal year in the water and Sanitary Severer funds. This option would reduce the fund reserve until such time that a general rate increase becomes necessary. In effect, this merely delays the rate increase to a future more convenient date when the full spectrum of utility costs can be analyzed at one time. Canchmian A water/sewer Goodwill program can be a beneficial addition to the City's utility systems. Other cities with these programs in place have found them to be manageable and cost-effective methods to provide much needed financial assistance to utility customers who, through no fault of their own, have experienced property damage or clean-up costs as a result of water/sewer flooding due to a problem. with City owned and maintained facilities. Some of these lases might be reimbursable to the customer via a modified homeowner "insurance policy, but there is usually a significant deductible amount to be paid by the homeowner. Experience has shown that these situations arise between 2 and 5 times a year in Kalispell. while annual costs would vary, over time the average annual Goodwill cost to the City to reimburse its utility customers when damage occurs from a problem with our water/sewer mains would be about $151,000. The majority of these costs would be related to sewer backups. water related problems are much less common. The potential impact of this on the current rates is approximately $0.021 1,000 gallons for sewer and water. The City' s insurance carrier, MMIA, has indicated support for such a program and has further stated that the community goodwill fostered by such a program can also help reduce future claims for damage whenever unfortunate problems With City utilities cause damages to a utility customer's property. Water Sewer Goodwill Policy Memo (2).doc Recommendation Based on the above informmation and MMIA's endorsement, I recommend that the City Council develop a water and sewer Goodwill policy for the City of Kalispell. The policy should include the following: * Written procedure/policy/guideline • An appointed committee to review claims • Claims only acted upon after MMIA's has responded to a claim investigation Committee can authorize payment up to $5,000 per claim • City Manager has the authority to authorize payment over $5,000 • Claimant must provide original receipts or written estimates for cleanup costs or damage • Claimant mint sign a form waiving related claims or actions against the City as a condition of payment Attachments Attached for your information are copies of data provided by Whitefish, Billings, Great Falls, and Missoula related to their existing water/sewer Goodwill programs. Water Sewer Goodwill Policy Memo (2),doc city Of Whitefish July 27, 2006 Mayor Feury and City Councilors City of Whitefish Whitefish, Montana Mayor Feury and Councilors Recommendation to Adopt a Goodwill Policy in Regards to property Damage Caused by water and wastewater Accidents Introduction/Hi t The City's water distribution and wastewater collection systems are occasionally subject to mechanical problems, such as pump failures and broken or clogged pipes. Some of these incidents result in damage to private property. The following policy is proposed as a means to offer limited financial assistance to affected property owners, under certain conditions. Current Re ort Two recent instances involving damage from broken water mains were flooding in th the lower level of the Downtowner Motel and basement flooding at a residence on 7 Street. Clogged City sewers have also caused wastewater to accumulate in crawl spaces and basements on rare occasions. The owner of the Downtowner Motel has submitted the attached information regarding a water main incident that occurred last December, including a request for compensation. We offer this to illustrate some of the problems our customers may face. If adopted, the process recommended below will be used to review the Downtowner's request. Some accidents, such as the Downtowner's flooding, involve third party contractors whose insurance may come into play and almost all accidents involve a claim to our insurance carrier. Although our insurance may pay a claim if the City has been negligent, they will often deny the claim if the incident was caused by an "act of god" such as extreme weather, or if the City can document reasonable maintenance prior to the accident. When a third party contractor is involved, our insurance carrier may pass the claim on to the contractor's insurance company. ECtJ'e believe it is appropriate, in some instances, for the City to offer limited compensation, beyond our insurance coverage. If raw sewage accumulates in someone's basement because a well maintained sewer clogs up for some odd reason or if a hard winter freeze breaks a water main and it floods a nearby building, it isn't the property owner's fault but the consequences can be very unpleasant and very expensive. Although we may not be legally liable, it only seems right to offer some help. We contacted other Montana communities and found that Billings, Great Falls and Butte have some form of "goodwill policy". We propose to work from Great Falls' example with a program as outlined in the following policy statement. WATERIwASTEWA TER DAMAGE CLAIM REVIEW COMMMITTEE POLICY& GUIDELINES t) The Committee shall meet on an as needed basis and include the following three members: Public Works Director Public Works Utility Supervisor Finance Director 2) All claims shall first be submitted to the City's insurance carrier and appropriate third party insurance carriers. The Committee shall consider the claim after the City's insurance carrier has responded. 3) The claimant's submittal to the Committee shall include invoices for labor and materials. If the claim includes cleanup or repair work performed by parties other than an established service provider the claimant shall provide written estimates prepared by established service providers to confirm the value of the work. 4) The Committee shall review claims on a case-bya-case basis and compensation shalt be considered in light of the facts surrounding that particular incident. Compensation may be denied or limited, particularly in cases involving third party liability or "Acts of God' ; such as extreme weather, earthquakes, etc. 5) The Committee may authorize payments up to $5,000 per claim and will make recommendations to the city Manager regarding larger requests. 5} The City Manager may authorize payments over $5, 000 per claim. 7] The City Manager's decision is final. 8) The claimant shall sign a form waiving related claims or actions against the City as a condition of payment. Financial Re uirement We recommend a maximum payment of $5,000 per claim and anticipate no more than 2 to 4 claims per year. Annual funding for this program would be through the Wastewater and Water Funds. Recommendation We respectfully recommend the City Council adopt the policy described above and thereby establish a goodwill program to compensate customers, under certain conditions, for damage attributed to City water and wastewater utilities. Sincerely, John C. Wilson Public Works WATER/WASTEWATER DAMAGE CLAIM REVIEW COMMMITTEE POLICY d GUIDELINES 1) The Committee shall meet an an as needed basis and include the following three members: Public Works Director Public Works Utility Supervisor Finance Director 2) All claims shall first be submitted to the City's insurance carrier and appropriate third party insurance carriers. The Committee shall consider the claim after the City's insurance carrier has responded. 3) The claimant's submittal to the Committee shall include invoices for labor and materials. If the claim includes cleanup or repair work performed by parties other than an established service provider the claimant shall provide written estimates prepared by established service providers to confirm the value of the work. 4) The Committee shalt review claims on a case -by -case basis and compensation shall be considered in light of the facts surrounding that particular incident. Compensation may be denied or limited , particularly in cases involving third party liability or "Acts of God'; such as extreme weather, earthquakes, etc. 5) The Committee may authorize payments up to $5., 000 per claim and will make recommendations to the City Manager regarding larger requests. 6) The City Manager may authorize payments over $5,000 per claim. 7) the claimant shall sign a form waiving related claims or actions against the City as a condition of payment. Adapted August 7, 2006 city Of Billings {date} Dear Public Utilities Customer: Below is the procedure to follow after you have experienced a wastewater backup that occurred as a result of stoppage in the ClMs sewer line. For health and safety reasons, we recommend that you have the affected area professionally cleaned as soon as possible. Retain your receipts for cleaning work, as these expenses may be reimbursed. 2. To file a damage claim with the City, please call JoLynn Yerger, Safety/Risk officer at 657--3061. Your claim will immediately be filed with the Montana Municipal Insurance Authority (MMIA), the Dity's liability insurance provider. Normally, an adjuster will contact you and a determination regarding City liability will be made within 7-10 days. 3. If MMIA denies your claim, please contact , at , to file your cleaning casts. The public Utilities Department will reimburse you up to a maximum of 1,000.00 for documented cleaning costs associated with a backup caused by stoppage in the City's sanitary sewer line. Sincerely, Superintendent, Distribution & Collection Public Utilities Department ACKNOWLEDGMENT I/We, the owner(s) of property located at Billings, Montana, hereby acknowledge receipt of the sum of $ , paid to me/us by the City of Billings. IMe further acknowledge that payment of said sum is made for cleanup costs incurred as a result of a sanitary sewer backup; that said payment is made voluntarily by the City; and that said payment is not an acknowledgment or admission of any liability or fault by the City. DATED THIS DAY OF , 20 OWNER OWNER OWNER OWNER {date} Name Address City, state Zip SUJ ECT: Sanitary Sewer Complaint — address of backupl-- Dear The city Of. Billings' public Works Department currently has a reimbursement program for damages incurred by a City sanitary sewer backup. The program will pay up to $1,000.00 in cleaning costs. In order to be reimbursed for the casts you recently incurred, please complete the attached acknowledgment form and return it, along with the cleaning receipts. We will then process the payment. If you have any questions, please contact me at Sincerely, [distribution & collection Superintendent Attachment City Of Great Falls WATER/SEWER COMMITTEE POLIO" Y & GUIDELINES 1) The Committee shall consist of three members as follows: • Utility Systems Supervisor • Utility Systems Foreman • Risk Manager 2} The Committee shall meet on an as needed basis. 3) All claims are initially sent to the MMIA for payment or denial of payment. 4) Only those who contact the City, after the MMIA.'s denial are acted on. S) Staff can authorize up to $5,000 per claim. 6} The City Manager has the authority to authorize payment over $5,000. 7) Program is administered by the water/Severer Committee. 8) Claimants must sign a waiver form. 9) Program is initially funded as follows: • $71P00 Sewer Administration Budget • $31000 — water Administration Budget 10) Payments will not based on an across-the-board figure. Each claim will be reviewed with a maximum dollar amount set at $5,000. Clauns gill not be paid in cases of "Acts of God" or clear liability on a third party. 11 ) Before paying any claim, bills must be submitted by the claimant and reviewed by the Committee. If claimant chooses to do cleanup themselves, they must provide a written estimate by a cleaning company as to the hours and costs to do the cleaning. July 19, 2004 RE: Sewer Back Up Date of Loss: une 23, 2004 Dear: The City of Great Falls Water/Sewer Committee has met regarding your claim for the above referenced incident. After careful consideration of the items you asked us to consider we are willing to offer you a final good will settlement of I have attached a copy of the breakdown for your reference. The Committee feels this is a fair offer. The Committee also reviewed the Montana Municipal Insurance Authorities decision. The City of great Falls has been reasonable in their inspections and maintenance of this line as well as in their response to the problems of the back up. The Montana Municipal Insurance Authority has determined the City of Great Falls was not negligent in their actions concerning this claim. We are willing to offer this goodwill settlement given the fact that it was the City's line. I have enclosed a copy of a Release Form that we are asking you to sign if you should accept our final offer. You may mail this foam to me or bring it in personally, whichever is more convenient for you. When we receive this release Farm, the City will issue you a check. Should you wish to discuss this further I can be reached at (406)455-8440. Sincerely, Kelly Audet Disk Management Specialist * RELEASE That for and in consideration of the sum of $ paid by the City of Great Falls, Montana, receipt of which is hereby acknowledged, do hereby release and discharge the City of Great Falls, a municipal corporation, all of its officers, employees and agents from any and all actions and causes of action, demands, claims of every kind and nature whatsoever arising out of the alleged water line repair causing damage to claimant's property located at . This Agreement shall be binding upon the heirs, successors and assigns of the -parties hereto. IN WITNESS WHEREOF, this Day of Claimant , 2006. Claimant has hereunto set their hands SUBSCRIBED AND SWORN to before me, the undersigned, a Notary Public for the State of Montana this - - - - - day of -- - -- -- - -- -- 12006. Signature Printed Name Notary Public for the State of Montana Residing at , Montana My Commission Expires: (NOTARY SEAL) City Of Missoula *+tam#r ++ ru Eligible Expenses To be coaddared, Umm cquam a" be ne - T` essW, reasonable and mentaw as al Contracting of a cleaning service b j Emergency e)penses. such as rental of heat - OD ers to prevent freezing if the heating systern is Go affected. c) Emergency housing and meads for owner(s) or tenant(s). ;f required because the savtary concidon of the sbrxture is unhealthy .for oc M man as a residence. od) Disposal of any contaminated material in an approved landfill site. el Actual cash value of the damaged personal property that must be replaced because it Cannot be repaired or leaned . - Estimates ao if the claimant chooses to perform cleanup and claim personal labor and materials costs, the claimant must provide a written es&nate from a c6 ni cleang company as to the work hours and ni costs to complete the job. This estimate will be used to substantiate the -necessary and reason- able- requirement ofthe Goodwill Policy. Reimbursements All claims for reimbursement must be acCorn- parced by original receipts and/or cost estimates. Actual cash value equals replacement cost of items of We kdnd and quality, less depreciation. for use, wear, age -and other applicable factors. Q Non-ligible Expenses Nor eligible for financial assistance: purport- 0 ed personal labor cosh pain and suffering, emo- CO co tional or mental distress, incor enience, air fare or travel expenses, lost wages{ lost business rev- enues. lost business profits,, or similar items. M WaiYer Agreement Claimants must sign an agreement waiving, any further calms against the City in order to re- (u ceive financial assistance - CD T1ds peNcy supwwdss my and A prkw resatudoas P4 to to" VM polikia an satyr bachJUP& The UdbrotieP In /fc kvcdure is outlined i t CU � CW Rem*Alop 3R30 r rI adopted Uwch 1996. i D Q Z Questioln'soo, Calf the offices listed below fbr further information, Wmtewater Treatment Plant 523-4880 523.4SS6 city of Missoula Finance O ftce 523-4929 �Clty of Missoula Public Works Departnnent 523-4520 i I&Iastewater D a, gd e I from City Sewer Backups? ****4*.;* + ,+..;*.**. Voluntary Goodwill Policy If you've ever had wastewater backed up in your residence from City sewer facilities, you know whd (rush afien is ... � 'he City of Missoula has a thorough sewer � one maintenance program. However, from irne to time, under unusual circumstances, O@Aissoula residents experience a backup of opwastewater into property they own or rent F- The City of Missoula has a Voluntary Goad- CD nnll Policy designed to help you receive assis-- cr ,ance if you qualify for it. This could occur if, (5 he wastewater problems originate in City ~ )wned or maintained facilities, such as in ;ewer mains, S.T.E.P. systems or pump sta- ions. Limited financial help with cleanup is available from the City in certain instances. 0 Why does the ' City of Missoula have a U) Voluntary Goodwill Policy? the City of Missoula wants to help citizens CD 'T naintain a healthy, safe and pleasant way of ife. Offering voluntary assistance to help Mth sewer backups in City sewer facilities is )ur way of helping you handle the incohve- Vence and cleanup as well as some of the -osts which may not be covered' by your own CE nsurance or the 013(s insurance: I B By following a few simple steps, LO you can avoid delays in determining what type of helpual for. ]� R d `Y w(ou may qualify for some assistance even if cr four insurance or the City's insurance does bi }ot cover the damage. We encourage you c p ask about possible assistance and submit i claim, even if you"re informed that the City W s not liable. Probiems in the sewer system an occur even though proper operation r� end maintenance has been performed. 0 Z Missoula's Voluntary Goodwill Policy is based on the following considerations: 4, Blockages in the 0Vs system of wastewa- ter main collection tines occur occasionally,. for a variety of reasons (such as foreign ob- :jests, grease, roots and other sources). a.. In many cases, .such blockages are not a result of any actions, inactions, negli- gence or fault of the City. *:- ' City sewer main backups may cause dam- age and inconvenience to owners or ten- ants of an affected structure. i The City wants to lessen the hardship resi- dents experience by providing some fi- nancial assistance, even though the City may not be responsible for the damage or the inconvenience. *:- The City wants to respond promptly to your questions; however, the City cannot provide assistance until after the Cityys ire surer has determined whether the City is liable for cleanup or damage_ r+i#� #*i#*! e4 lee Here's what you should do if you need assistance. l . Report -the problem to the Wastewater TreatrTrent Plantat 523-4880 or 5234885. 2 Waswwater crews w411 locate. the blockage_ if it is In the 'servrce lateral. line (the connection from your structure to the city main), the City will a& vise you to call a plumber to dear the blockage. Such: blockages are the homeowners flnandal responsibility. a if the blockage is In the CiVs main Um or is caused by a malfunction of City -owned or maintained facilities such as S,T.E.P. systems, the City mainte- nance crew wail resolve the problem. The crew Will provide the occupant. with a copy of this bro- chure and advice on how to file a claim. 4. To be considered for financial 'assistance, you must submit a. claim form to the City_ fail the- Fi- nance Cffiee at 5234929 for claims information. 5 The City will provide assistance only if the CiVs insurer has denied the claim. In that case, the City will be authorized to approve some goodWitas- sistance to the property owner and/or tenant for cleanup. T. Cleanup expenses are limited to chose considered necessary, reasonable, and documentable. Esti- mates and original receipts are required. It will be the property owner's or tenant's responsibil- ity to perform the cleanup or hire a cleaning corr)- pany. (See "Eligible Expenses" for detail.j- B. The City will reimburse the claimant only to the extent that expenses exceed or are not covered by a homeowner, renter, or business insurance policy. No payment will be made of damages due to "Acts of God` or where there is clear liability by a property owner or a third partyPayment will not be made fbr indirect costs. (See `Eligible Ex- penses" for additional detail.) TIPS ON FIRING CLEANING AND RENOVATION SERVICES Read, the City's Voluntary Goodwill brochure thoroughly. You should always get three estimates before any contract work is to be done. The City requires three estimates for renovation work done after the initial clean- up for payment to be made. Before reimbursement can be made, you or the contractors you've hired must provide documentation of damaged items 'or the actual items for- Inspection by, the City before they are disposed of. The C ty's Voluntary Goodwill RQ-licy may not cover all services offered or recommended 'by a cleaningL or renovation company. You will be responsible for any costs not covered in the voluntary i Goodwill Policy. Most cleaning and renovation companies are repo#able, but don't be taken. advantage' of during a stressful time by any contractor. - The C 's voluntary Goodwill Policy does not necessarily cover replacement value of .items that cannot be, cleaped or repaired, The pollcy pays only the actual cash value or depreciated value of a da- maged' item. 1 All claims must be submitted within 90 days of the sewage , back up to receive reins bu rserri ent. ' If you have any questions or concerns, please call- the Wastewater . Uivislo n at 523- 17 4880 g I " d I 006 112aBS L90t? 16.0l 6t7- 8S2 - 90t, dIMM u-1noss I w : woaj u92 : eo 9002 - 2 - nON WAIVER AND RELEASE OF ALL CLAIMS TO RECEIVE VOLUNTARY GOODWILL POLICY PAYMENT FOR SANITARY SEWER BACKUP Ilvve, Name(s) Address Missoula MT 59$ , in order to participate in and receive some City voluntary goodwill policy money to assist with recovery involving the city sanitary sewer system and a backup at , Missoula, Montana, on Address of sanitary sewer backup Date of backup do hereby for ourselves and our heirs, executors, administrators, successors and assigns in exchange for receiving a City voluntary goodwill policy payment of $ do hereby Amount in exchange for receipt of this money, release, acquit and forever discharge the City of Missoula and its agents, officers and employees from all manner of legal actions, claims, cause of action, demands, rights, damages, costs, etc., in law or equity, which we may have now or in the future, against said City of Missoula and their agents, officers and employees by reason of the sanitary sewer backup identified herein including the processing of this voluntary goodvAH policy claim. We further state that we understand that the City of Missoula does not consider itself negligent in this matter but that pursuant to the city of Missoula's voluntary goodwill policy for assisting individuals in my/our circumstances who have experienced sanitary sewer main backup damage the City is voluntarily offering to assist me/ us with this payment. The undersigned further declare and represent that no promise, inducement or agreement not herein expressed has been made to the undersigned, that this Release is voluntarily made and that the terms of this Release are contractually binding. SIGNED this day of , 200 State of Montana } )ss. County of Missoula This instrument was acknowledged before me on this day of Zoo , by Kinfory Pi jhlir- few tha Rtata of RAnntnna