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2. The County recognizes that funding for operating, and maintenance costs is limited for local Community Centres, Agricultural Societies, County Fire Departments and non-profit societies that operate a facility accessible to the public. It is the intention of the County to support these organizations through the Public Works Donations to Organizations Policy 32.1.13. 

   Organizations may request up to the accumulation of $2,000 in value for goods or services. Requests exceeding $2,000 shall be brought to Council for consideration.

4. Name of the organization making the request:
6. Mailing Address:
8. City:
9. Province:
10. Postal Code:
12. Contacts Name:
14. Phone Number:
15. Email:
17. Select the type of service being requested:

    Please select all services you are requesting.

    1. Gravel
    2. Dust Control
    3. Roll Off Bin (includes drop off/pick up)
    4. Snow Clearing
    5. Grass Mowing
    6. Maintenance Work
18. Date the services is required:
    Date the services is required: Start Date

    Date the services is required: Start Time

    —

    Date the services is required: End Date

    Date the services is required: End Time
20. Please provide any other relevant information related to your request:
22. 
24. The above named organization hereby indemnifies the County against all actions, suits, claims and demands whatsoever by any person, firm or corporation arising out of or resulting from the County providing the above requested services.

    1. I agree.
26. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, and 2) by signing in this alternate manner, your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I agree.
28. Electronic Signature
30. Freedom of Information and Protection of Privacy Act

    Section 33(c) of the FOIP Act authorizes the County of Wetaskiwin No. 10 to collect this personal information for the purpose of "requesting a Public Works Donation to Organizations”. If you wish to inquire about the collection, use, and disclosure of personal information, or if you have questions about correcting your personal information, please contact the FOIP Coordinator: foip@county10.ca; phone 780-352-3321 (ext. 2270); or, toll free at 1-800-661-4125.

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field