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E OPT -OUT FORM <br />To cancel your service line protection, please remove and <br />return this completed form to Owatonna Public Utilities. <br />Your service line protection will be canceled within <br />5 business days upon receipt of this completed form. <br />First Name (as it appears on account) <br />Last Name (as it appears on account) <br />Address <br />Address 2 <br />MN <br />City State Zip <br />Phone Number <br />0- <br />By signing below, I certify that I am the customer responsible <br />for utilities at the above listed address. I understand that <br />by canceling my Water Service Line Protection I will be <br />responsible for all costs to replace and restore my water <br />service line if any damage occurs, including but not limited to <br />restoration of roadway, public right of way, personal property <br />and service line replacement. I understand that OPU will <br />perform a pre -inspection should I choose to add Water Service <br />Line Protection in the future. <br />Signature Date <br />A-- <br />OwAnTonnnn <br />PUBLIC UTILITIES Rev 1/23 <br />79 <br />