New Construction- Pole Attachment Application

Fill out this application if you are requesting attachment to SESD poles or facilities under an existing pole attachment agreement.

There is a $200.00 application fee due with this application

Today's Date (required)

Type of Applicant (required)

Contractor (acting on behalf of Business or Corporation)

Business or Corporation

City, County, other local government entity

Company Name (required)

Business Tax Id/EIN

Applicant First Name (required)

Applicant Last Name (required)

Applicant Phone (required)

Applicant Mailing Address (required)

Applicant Email (required)

Project Address (required)

Project City & County (required)

Project Parcel # (list closest parcel# to project) (required)

Subdivision Name (if applicable)

Project Contractor business name (required)

Project Contractor's License # (required)

Project Contractor phone (required)

Project Contractor email

Project Autocad Files- upload

Project PDF Files (required)

Project Google Map Coordinates

Terms & Conditions - As the duly authorized agent of a Developer, Contractor, or Builder (hereinafter, "Contractor"), I herewith agree to indemnify and hold South Utah Valley Electric (hereinafter “District"), its officers; agents, officials and employees, harmless from any action, causes of action, claims for relief, demands, damages, expenses, costs, fees, or compensation, whether or not said actions, causes of action, claims for relief, demands, damages, costs, fees, expenses and/or compensations are known or unknown, are in law or equity, and without limitation, all claims of relief which can be set forth through a complaint or otherwise that may arise out of the acts or omissions, negligent or otherwise of the Contractor, Contractor's officers, officials, agents, or employees, District, or its officer's, officials, agents, or employees, or any person or persons. Contractor warrants that Contractor has acquired and will maintain Worker's Compensation Insurance as well as Liability Insurance sufficient to support the promises, releases and waivers contained in this agreement. Contractor acknowledges that Contractor has been advised to consult legal counsel and have had the opportunity to consult with legal counsel prior to entering into this release of liability. Contractor understands and agrees that, by signing this Hold Harmless agreement, that Contractor relinquishes all rights or claims to adjudication or recourse to which Contractor may be entitled in relation to any liability arising under this contract. Contractor warrants that Contractor enters into this agreement with full knowledge of the meaning and future effect of the promises, releases and waivers contained herein. Contractor warrants that Contractor has entered into the releases and waivers contained in this Agreement voluntarily and makes them without any duress or undue influence of any nature by any person or entity. · Contractor agrees to assume all risk, chance or hazard that any loss sustained by Contractor or any other person or entity may be greater or more extensive than is known, anticipated or expected. (required)

I agree with the Terms & Conditions, & agree to Indemnify the District

Pole Attachment Table Upload (required)

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