Worksheet 4 Project Tracking #: Operations & Maintenance Agreement Information Date:

Submitted information will be used to prepare the Operations and Maintenance (O&M) Agreement for all proposed stormwater management practices. Please note that incomplete or incorrect information will prevent this project from proceeding to the Post Construction Stormwater Management Plan (PCSMP) Review Stage. Please contact PWD Stormwater Plan Review at 215-685-6387 or [email protected] with any questions or concerns regarding this worksheet. Legal Address(es) of Property(s) Under Development: 1. Please provide the address for each property under development as they appear according to Office of Property Assessment (OPA) Records. Attach additional sheets as needed. Please note that OPA parcels may be different from mailing addresses. If a consolidation or subdivision is proposed, please refer to the Lot Consolidation or Sub-division section below.

OPA Account # Street Address Zip Code OPA Address 1 Phila., PA

OPA Address 2 Phila., PA

OPA Address 3 Phila., PA

OPA Address 4 Phila., PA

Registered Owner(s) of the Property: 2. Please name all Owner(s) as listed on the property deed(s). If the property has multiple owners, attach additional sheets as needed. If the developer does not yet own the property but is under negotiations with the current property owner, please fill out this section with the developer’s information and submit additional documentation (such as an Agreement of Sale) to demonstrate the current owner’s intent to convey the property to the developer.

Property Owner Official name(s) of individual(s) or business(es) Signatory Name Please provide the full name of the individual who will be signing the O&M Agreement as/on behalf of the owner. Signatory Business Title Corporations: President or Vice President Limited Partnerships (LPs): General Partner, or if a corporation is the general partner, then President or VP of the corporation Limited Liability Companies (LLCs): Member or Manager, depending on how the LLC is managed For all others: List the business title, and submit a letter of authorization for the signatory confirming his/her ability to bind the owner organization in legal agreements.

Mailing Address Address of the signatory, to whom PWD will return the signed/recorded agreements

City State Zip Code

Phone # E-mail

Lot Consolidation or Sub-division: (If applicable) Version 3.0 Last Modified 7/1/2015 3. If you plan to consolidate or subdivide the parcel(s) under development, please submit a list of the proposed new address(es) and OPA account number(s). Please also submit documentation from the City of intent to change the address(es) and documentation from the OPA of the new OPA account number(s). Legal Description of the Property(s): 4. Please submit a metes-and-bounds description for each property under development with reference to the property address. All property descriptions provided must describe full parcels. When consolidating or subdividing an existing parcel(s), please provide the legal description for each parcel with reference to its proposed new property address. Please note that the legal property description must be submitted in an editable format, such as a Word document, from which PWD can copy text and paste it directly into the O&M Agreement. PDFs or photo files (such as jpeg, bitmap, etc.) will not be accepted.

Version 3.0 Last Modified 7/1/2015