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Water Conservation Rebate - High Efficiency Toilet Rev. 2/2/2021 HIGH-EFFICIENCY TOILET REBATE PROGRAM Please carefully read all the information above before filling out this application. Date: How did you hear about this program? Customer Name: (As you would like it to appear on the check; please print clearly) Customer Address: Installation Address: (If different from above) Phone #: Email Address: Make of New Toilet: _______________ Model name and number of new toilet: Gallons/Flush New Toilet: _____________________________ Business name and location purchased: (Retailer must be located within San Luis Obispo County) Make and Model of Existing Toilet: Gallons/flush Existing Toilet: Number of Toilets being replaced: What is your connection to the property where the turf is being replaced: ___Property Owner ___Tenant Water Account Number: (This information may be obtained from a previous water bill) By signing below, you indicate that you have read and complied with the requirements of the High Efficiency Toilet Rebate Program as outlined above. You must call for an inspection: (805) 773-4656. Authorized Signature Date CITY USE ONLY Date Received: # of Toilets: Pre-Inspection Date: Post-Inspection Date: Approved / Signature: Rev. 2/2/2021 HIGH-EFFICIENCY TOILET WATER CONSERVATION PROGRAM Your Water Conservation Representative: Madeline Kacsinta - mkacsinta@pismobeach.org This program is subject to change without notice and is subject to the availability of funding. Program Goal: To encourage a permanent reduction in the amount of water used for plumbing fixtures. Background: Typically, toilets use the most water in your home. Replacing a typical 3.5 gallon toilet with a 1.28 gallon model will save a family of four about 12,964 gallons per year. Receive up to a $100 rebate for each toilet replaced with a new high-efficiency toilet. Continue to save money each month on your water bill! Rebate Amount Minimum Gallons/Flush Maximum Rebate Amount $100 Per Toilet Existing 3.5 Gallons/Flush to New 1.28 Gallons/Flush or less $300 (3 Toilets) How to Participate: 1. Fill out application: See first page of this document for application 2. E-mail, mail, or turn in application to a City representative. <<<< Include a photo of your existing toliet to be converted >>>>> Mail: Attn Madeline Kacsinta, 760 Mattie Road, Pismo Beach CA 93449 E-mail: mkacsinta@pismobeach.org Phone: (805)773-7060 3. Pre-installation inspection of existing toilet: City Staff will contact you to schedule an inspection. 4. Make Approved Update: City Staff will give approval at pre-installation inspection. 5. Post-Installation Inspection: After conversions are 100% completed, call to schedule a post-installation inspection site visit with City Representative to confirm all conversions have been in accordance with the terms and conditions of the rebate. (PLEASE HAVE VALID, DATED SALES RECEIPT TO TURN IN TO THE INSPECTOR, IF YOU HAVE ONE) 6. City Will Mail Rebate Check: Once your post-installation inspection has passed, the City Representative will contact the City’s Finance Department to mail a check to the address on the application. Please allow 30 days from post-installation inspection to receive the rebate. NOTE: The City of Pismo Beach does not warrant or assume any liability for the design, manufacture, installation or operation of any toilet obtained under this program. Rev. 2/2/2021 Terms and Conditions: PLEASE READ THIS INFORMATION CAREFULLY. In order to receive a City rebate for purchasing a qualifying High-Efficiency Toilet, the applicant must completely fill out the application and comply with the requirements on this form. Failure to do so may result in disqualification. 1. The property receiving the rebate must be a water customer of the City of Pismo Beach. 2. Only one rebate will be issued per household. 3. Your utility account must be in good standing. 4. The toilet being replaced must be a non efficient model (3.5 gallons per flush or greater). 5. Single-family, multi-family, Homeowner Associations, and certain mixed-used accounts are eligible. 6. The toilet must be a 1.28 gallon per flush toilet or less. 7. The purchase must be made on or after February 2, 2021. The City will not honor rebates for used or reconditioned toilets, or toilets purchased prior to the above date. 8. The application form must be completely filled out. 9. Applicant must attach a legible copy of a valid, dated sales receipt to this application. 10. Installations must be completed within six (6) months following receipt of the City’s executed agreement. Once the City receives notice of installation project completion, any wait time for the City’s final inspection shall not be counted against this six-month period of time. The converted area must remain in compliance with all program terms and conditions for a period of five (5) years following receipt of the rebate. An applicant may be required to refund the entire rebate, or a portion thereof, if rebate program terms and conditions are violated. Notwithstanding the foregoing, this requirement is void upon transfer of ownership. 11. Once the City is notified of an installation project’s completion, the City will conduct an inspection to verify program compliance. If the installation fails inspection, the applicant will be permitted to bring the installation project into compliance with the program terms and conditions for a period of sixty (60) days or the remainder of the six-month period, whichever is greater. 12. The City enforces only the terms and conditions of this agreement. The applicant is solely responsible for complying with any and all laws, regulations, policies, conditions, covenants and restrictions that may apply and for any and all liabilities arising out of an installation project. Applicants are encouraged to consult any applicable covenants, conditions and restrictions (”CC&Rs”) or neighborhood Homeowner’s Association (“HOA”) regulations that may apply to an anticipated installation project prior to submitting an application with the City. Applicants must also comply with all state and local laws relating to landscape maintenance. The quality, maintenance and appearance of the installation are the exclusive responsibility of the applicant. Rebates may be considered taxable income. 13. The High-Efficiency Toilet Rebate Application must be submitted to the City of Pismo Beach and the applicant must participate in a pre-conversion site review conducted by the City prior to the removal of existing toilet. Conversions that are initiated without the City’s approval are ineligible. 14. Retailer must be located within San Luis Obispo County. 15. The toilet must be installed in accordance with all relevant building codes prior to submittal. 16. Schedule a post-installation site visit with a City of Pismo Beach representative once installation has been completed in accordance with the terms and conditions of the rebate program. 17. High-efficient toilet may be inspected at any time by the City to determine ongoing compliance with the program. Rev. 2/2/2021 For further information, please contact the Public Works Department at 773-4656, email your Water Conservation Representative at mkacsinta@pismobeach.org, or go to www.thinkh2onow.com for more water conservation information. The number of rebates is limited. Only one rebate will be issued per household. NOTE: The City of Pismo Beach does not warrant or assume any liability for the design, manufacture, installation or operation of any toilet obtained under this program.