Water Conservation Incentive for High Efficiency Fixtures - Application for Customer Rebate

Name:

Phone Number:

Service Address:

Mailing Address (if different):

Email:

Model Number of Fixture:

Upload Receipts:

I hereby certify that I am a water utility customer of the City of DeLand and that I am the owner or agent for the owner of the above referenced property. I certify that I have purchased and installed high efficiency fixtures or equipment which meets the minimum requirements of the U.S. Environmental Protection Agency (EPA) Water Sense Program or the Uniform North American Requirements (UNAR) guideline specifications, included in the following Table:

Plumbing Fixture	Maximum Flow Rate	Water Bill Credit
Rain Barrel	Minimum capacity 50 gal US	$20.00
Lavatory private	1.0 gpm at 60 psi	$20.00
Lavatory, Public, metered	.25 gallons per metering cycle	$50.00
Lavatory, Public, non-metered	.5 gpm at 60 psi	$25.00
Shower head	1.5 gpm at 80 psi	$20.00
Sink faucet	1.0 gpm at 60 psi	$20.00
Water Closet, High Efficiency	1.28 gallons per flushing cycle	$50.00
Water Closet, High Efficiency, Dual Flush	1.28/0.8 gallons per flushing cycle	$100.00
Urinal	Waterless or .5 gallons per flushing cycle	$100.00
Dishwasher, Residential	6.5 gallons per cycle or less(Energy Star/Water Sense Certified)	$50.00
Dishwater, Commercial	Less than 1.2 gals per rack for fill and dump machines and less than .9 gals per rack for all other types of machines	$100.00
Under Counter Machines	1.0 gal or less per rack for high temperature machines and 1.7 gals per rack for low temperature machines	$100.00
Washing Machine	Water factor* of 8 or lower (Energy Star/Water Sense Certified)	$100.00

*Gallons per cycle per cubic foot

Washing machines must replace a washer that is not a front loading washer. Equipment or high efficiency fixtures must be purchased on or after January 6th, 2009 to be eligible under this program. I have attached the invoice for the appliance(s) purchased.

I agree to indemnify and hold harmless and defend the City of DeLand and all of its Commissioners, officers, agents, employees or authorized agents and representatives from any claims, suits, actions, losses or liability or every kind, nature and description, including but not limited to, the delivery, installation, product malfunction, plumbing malfunction, maintenance or use of appliances purchased through this program. Further, I understand that installation and compliance with any and all law, rules, and regulations of any governmental entity or homeowner's association are solely my responsibility. The City of DeLand does not warrant or otherwise guarantee the equipment of fixture(s) installed or their operation.

I agree that I will also allow a representative of the local government utility to inspect the installation of the high efficiency fixture(s) or equipment within 6 months of installation. If access for an inspection is denied, I understand that I will forfeit all claim(s) for credit under this program. I understand that credit on an existing water utility account may take up to sixty (60) days to post after an inspection and that in order to be eligible for this program, my water utility account must be current.

Disclaimer:

Application for Customer Rebate (Maximum of $250.00 per premise)
Failure to include Receipt(s) for high efficiency fixture(s) or equipment so will delay or forfeit your rebate.

Signature:

Date:

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Water Conservation Form

Water Conservation Incentive for High Efficiency Fixtures - Application for Customer Rebate

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