Form Test - Town of Timnath

TIMNATH RESIDENT ANNUAL RESERVOIR PERMITS FOR 2023

Permits Being Requested (check all that apply)(Required)

RESIDENT Annual Shore Permit - FREE

RESIDENT Annual Motorized - $300

RESIDENT Non-Motorized - $30 (type quantity in text box below.)

RESIDENT Non-Motorized - SENIOR DISCOUNT - $20 (type quantity in text box below.)

RESIDENT Single Day Use Motorized Boat or Trailed Non- Motorized Permit- $75

Resident Annual Shore Permit - FREE

Price:

Resident Annual Motorized - $300

Price:

RESIDENT Non-Motorized - $30 (type quantity in text box below.)

Price: $30.00

Resident Non Motorized - SENIOR (65+) - $20

Price: $20.00

Resident Single Day Use Motorized Permit - $75

Price:

Total Fees

*This is the amount that you will enter into the payment portal to obtain your permit. The payment portal does charge a nominal processing fee.

Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Driver's License Number and State Issued(Required)

Vehicle License Plate Number and State Issued(Required)

Trailer License Plate Number and State Issued:(Required)

REQUIRED for any motorized boat trailer.

List Description of each NON-MOTORIZED Boat to be included in this Permit (enter N/A if not applicable)(Required)

All boats must have a permit sticker.

Current Boat Registration (Required for all motorized craft, including those w/trolling motors, and sailboats)(Required)

Max. file size: 128 MB.

Permits will not be issued for motorized boats without proof of CURRENT registration. Outdated or expired registration can not be accepted.

Proof of Insurance (Required for all motorized craft, including those w/ trolling motors and sailboats)(Required)

Max. file size: 128 MB.

SUBMITTED PROOF OF INSURANCE MUST INCLUDE DECLARATION PAGE FROM POLICY (SHOWING ALL COVERAGES) AND EFFECTIVE DATES OF COVERAGE. MUST INCLUDE $300K OF LIABILITY INSURANCE. BINDERS, APPLICATIONS OR RECEIPTS ARE NOT ACCEPTABLE.

List Description of each MOTORIZED Boat (make/model/horsepower) to be included in this Permit (enter N/A if not applicable)(Required)

Motorized Boats Only: List any/all person(s) residing at the address above that may legally operate the boat. At least one person listed on this permit must be present with the boat when on Timnath Reservoir. (enter N/A if not applicable)(Required)

If applying for a Single Day Use Trailered Non-Motorized Permit please check "yes" and provide the required items.*

Yes - my non-motorized craft requires a trailer.

*Required to launch trailered, non-motorized, craft.

REQUIRED: Upload Trailer Registration

Max. file size: 128 MB.

REQUIRED: Upload Photo of Trailer License Plate

Max. file size: 128 MB.

REQUIRED: Upload Proof of Insurance for Trailer

Max. file size: 128 MB.

Timnath Reservoir Shore Use Terms and Conditions Waiver

I/we hereby agree to obey the rules and regulations of the Town of Timnath and the State of Colorado applicable to shore use and boating at the Timnath Reservoir. A copy of these rules and regulations is made part hereof, and reference thereto with the same force and effect set forth herein, in every particular. I/we agree to indemnify, defend, hold harmless the Town of Timnath, its officers, agents and employees from all claims and demands of every kind of nature for injury or damage, either to myself, my guests, or made by a third party, arising from injury to the undersigned, or damage to my property or the property of others, arising out of or in connection with the use of the reservoir property. In applying for this shore use permit, I understand that: ▪ I have received and read a copy of the current Timnath Reservoir Use Policy inclusive of all Regulations contained therein.

For your reference, please read the Timnath Reservoir Use Policy.

▪ The permit allows me to utilize the shore areas of the reservoir until the end of the current boating season. ▪ Permits are non-transferrable. ▪ The Town will not refund permit fees under any circumstance. ▪ The Town’s authorized representative or a Timnath Police Officer may limit or revoke a permit for violation of any rule of conduct, policy, or county/town ordinance. If a permit is revoked at any time due to a violation, me and my family members will not be allowed to purchase or acquire another permit until the subsequent season.

Terms and Conditions Acknowledgement (check box below)(Required)

I have read, and agree to the Timnath Reservoir Shore Use Terms and Conditions Waiver

By my electronic signature on this application/form I acknowledge that I have read, and agree to, the Timnath Reservoir Shore Use Terms and Conditions Waiver. I also hereby certify that the information provided in this application is complete, true, and correct to the best of my knowledge. If it is discovered that the information provided was falsified, the Town of Timnath reserves the right to revoke your passes without a refund at any point during the season.

I declare, under penalty of perjury, that the statements made herein are made in good faith, and are true, correct, and complete, to the best of my knowledge.

Signature of Resident(Required)

First Last

Date(Required)

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