City of Racine Forestry Division
Print Form
WOOD CHIPS REQUEST
Requestor (Property Owner)
First/Last Name:
Home Phone:
Street Address:
Cell Phone:
City:
St:
Zip:
Email Address:
Select Quantity :
12 Yards (Approximate)
25 Yards (Approximate)
Return Completed Request Form to: PRCS, 800 Center Street, Room 127, Racine
The undersigned Requestor offers to receive waste wood chips from the City of Racine and acknowledges and agrees
to the following terms and conditions:
1) Definition. Wood chips are defined as the chipped by-products of tree pruning and removal operations. Chipped
by-products may include stems, branches, leaves, saw dust, bark and other debris. They may be of varying size, color and
texture. They may be suitable for mulch and landscaping purposes.
2) Quantity. Loads are based upon a 12 yard dump box and/or a 25 yard dump box. The actual amount received
may be more or less than the 12 cubic yards or 25 cubic yards selected.
3) Delivery. Once the form is received, your site will be evaluated and if approved, it will be added to a list and
delivered according to the proximity to our work sites. PRCS Forestry Division Staff will attempt to contact you by telephone
prior to delivery, but may proceed with delivery regardless of actual notice to Requestor. Delivery area is Racine County, east
of I-94. The undersigned requestor hereby agrees to comply with local ordinances governing wood chip use and storage.
********
4) Hold Harmless. Requestor understands and agrees that it is obtaining the wood chips in an as-is condition and
City of Racine makes no representation or warranty of the suitability of the wood chips for any use or purpose whatsoever. In
consideration for the wood chips received or to be received hereunder the Requestor hereby covenants NOT TO SUE and
further holds harmless the City of Racine, its departments, officers, employees and agents from and against any and all
property damage, bodily injury or any other type of damage or loss whatsoever arising out of the delivery, or provision of
wood chips to Requestor as described herein. Requestor is aware that damages to property may result from weight of the
truck used for delivery of the wood chips, or the act of dumping, including the rolling and/or bouncing of individual pieces
which may strike nearby objects or persons.
********
5) Access. The truck requires an 11' wide and 14' high access to area where wood is to be dumped. Truck weight
when fully loaded is approximately 46,500 lbs. and may damage sidewalk, turf, etc. Requestor is solely responsible for
identifying the dump area, clearing the path for the truck to access the dump area, and clearing the dump area to prevent
damage to persons or property.
Owner's Signature Required:
Owner's Signature
Print Name
Please Also Complete Reverse Side
FORESTRY DIVISION USE ONLY
Date Ordered
Date Delivered
Delivered By
Date
PLEASE DRAW A MAP of the residence/property & indicate the EXACT LOCATION where you would like to
have the wood chips dumped. Please be detailed. Include streets, driveway, etc.
N
W
E
S