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2. Applicant:*
4. Contact Name:*
5. Contact Phone Number:*
7. Contact Email Address:*
9. Address:*
11. City:*
12. State:*
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13. Zip Code:*
17. Event Name:*
19. Event Website:
21. Event Start Date:*
    Event Start Date:
22. Event Start Time:*
    Event Start Time:
24. Event End Date:*
    Event End Date:
25. Event End Time:*
    Event End Time:
27. Event Location/Address:*
29. Expected Number of Attendees:*
30. Is the event open to the public?*

    1. Yes
    2. No
31. Is the event not-for-profit?*

    1. Yes
    2. No
33. Does the site have a live water connection (i.e. hose bib)?*

    1. Yes
    2. No
35. Please provide a brief description of your event:*
37. Additional Notes:
41. Please read and agree to the following. By checking the box below and submitting this application, Applicant agrees to the following terms.*

    • I understand and agree that no sale or distribution of bottled water by vendors or event organizers is permitted as a condition of service.
    • I understand that Durham H₂O 2 Go must be situated in a prominent location agreeable to DWM staff with adequate room for set-up and adequate egress from the site. Adjacent space is required for a Water Management outreach booth/space. The space must allow for pull-in and pull-out access (i.e. no backing should be required to place or remove H₂O 2 Go from the site).
    • I understand that Insurance coverage is necessary in order to protect yourself and the City against any possible litigation as a result of my event and that all groups external to the City of Durham using Durham H₂O 2 Go must have Liability insurance coverage. The type of insurance coverage required is comprehensive general liability, inclusive of bodily injury and property damage, in the amount of $2,000,000.00 per occurrence, and that the City requires a CERTIFICATE OF INSURANCE naming the City of Durham as additional insured. I will provide proof of this insurance at least one week in advance of the event date.
    • I acknowledge that Durham H₂O 2 Go provides emergency potable water supply to Durham residents. In the event that the City determines that there is water emergency, the water emergency will take precedence over booked events, and Water Management staff reserves the right to cancel attendance at an event or remove Durham H₂O 2 Go from an event in order to provide water to the emergency situation.
    • I acknowledge that the City of Durham has no control over a mechanical malfunction of the Durham H₂O 2 Go that may occur during an event. In the event of a mechanical malfunction, the City of Durham reserves the right to remove or discontinue use of H₂O 2 Go from an event.
    • By submitting this application, the applicant and affiliated organization(s) agree to hold harmless, the City of Durham , its agents, employees, officers and contractors from and against all liabilities, claims, demands, judgements, cost of fees including without limitation reasonable attorneys fees arising in a manner from and all use of the equipment and agree to be bound by these rules.

    1. I understand and agree to the items noted above.
43. Full Name:*
44. Today's Date:*
    Today's Date:
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field