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Commercial Backflow Preventer Registered Tester Application

 

Company Information

 

Provide a copy of both of the following current years’ documentation:

1. Valid City of Medicine Hat Business License

2. Certificate of active general contractual liability insurance coverage during the registration period in the amount of five million dollars ($5,000,000) per occurrence with the City of Medicine Hat named as an additional insured.

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Tester Information

Complete this section and provide the following:

 

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Test Kit Equipment Information

Complete this section and provide the following:

 

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All information on this application is correct and true to the best of my knowledge. I have read, understand and I agree to comply with the above Backflow Preventer Tester Requirements and the above Backflow Preventer Testing, Reporting and Related Responsibilities.

Note: The City of Medicine Hat provides a list of Registered BFP Testers, which is updated continually, to customers with BFPs that require testing.

By submitting this application/form you acknowledge and agree that any electronic signature provided by you herein is the same as a handwritten signature for the purposes of legality, validity, enforceability, and admissibility.

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