REBATE PROGRAM APPLICATION Instructions: Completely fill out the application and submit to Sacramento Suburban Water District. 1. Name and Address 2. Application Date: Applicant Name (Rebate Check/Credit Payable To) Mailing Address City State Zip Company Name (if different than Applicant Name) Daytime Phone No. Email Site Name and Site Address (For Commercial, Industrial, and Institutional properties or if different from Mailing Address above) City State Zip Water Account Number Site Assessor s Parcel Number (APN)* *APN can be found online by County. Sacramento County: assessorparcelviewer.saccounty.net/, Check Desired Rebate/s Irrigation Efficiency Upgrades Clothes Washer Pool Cover Weather Based Irrigation Controller Rain Sensor Toilet Agreement I irrevocably authorize Sacramento Suburban Water District (District) to use or reproduce any and all photographs which have been taken of my property as part of the Rebate Program by the District or the District s authorized agent(s) for any purpose determined by the District without compensation or further notice to me. I have read and understand the Rebate Program information as stated in the Program Terms and Conditions listed in Section 3, Section 4 and Section 5 of this application. I understand that by signing below, I agree to allow an official from Sacramento Suburban Water District to verify the installation of the equipment at said property. I agree to indemnify and hold the District and their respective directors, officers, employees and agents, harmless from any and all liability or claims for damage, including any attorneys fees and costs, connected to or in any way arising from the Rebate Program, the inspection of the premises to verify proper installation, and any other activity related to this program. AUTHORIZED SIGNATURE DATE Yes I understand that by participating in any of SSWD s rebate programs that information regarding my project and property may be made available to the public. Please return all of my original receipts that have been supplied as part of this rebate process. Office Use Only Pre-Qualification Date: Post-Installation Inspection Date: By: By: Page 1 of 4
3. Instructions a. Submit a completed and signed application to the District via U.S. mail or dropped off at the District s Administration Office located at 3701 Marconi Avenue, Suite 100, Sacramento, CA 95821. Once the application has been received and rebate funds have been identified, a District representative will contact you to schedule a Pre-Qualification Water-Wise House Call (if applicable), which includes a site visit and audit of your outdoor irrigation system. b. Once the Pre-Qualification Evaluation has been completed (if applicable), the District will provide you with information regarding equipment/materials that are approved for purchase and eligible for a rebate. c. The purchase and installation of all approved equipment must be completed within 90 days of the Pre- Installation Evaluation. A Post-Installation Evaluation (will include site visit) must also be scheduled with the District within 90 days from the date of the Pre-Qualification Evaluation. The District will give you instructions on how to schedule the Post-Installation Evaluation. d. At the time of the Post-Installation Inspection, you must provide the Pre-Qualification Evaluation form and original receipts to a District representative. Submission of the receipts and form are required to be eligible for a rebate under this Program. If a contractor purchased the materials, you must request a detailed invoice showing separate line-items for materials and the individual cost of the materials. Rebates will not be processed until a Post-Installation Evaluation has occurred (if applicable). e. Once a Post-Installation Evaluation is complete and the appropriate receipts are submitted, a rebate will be issued by the District within 90 days from the date of the Post-Installation Evaluation. In most cases, rebate checks will be made payable to the applicant and mailed to the address provided on the application. f. Customers are required to complete the IRS form W-9 and turn it in with the rebate application. 4. Rebate Terms and Conditions a. The applicant applying for the rebate must be a water service customer of Sacramento Suburban Water District (District) and the site where the equipment is to be installed must receive water service from the District. b. Participants are eligible for one rebate per parcel, per rebate item, per funding cycle. c. Any materials and/or equipment purchased before April 1, 2015 will not be eligible for rebate funding. d. Rebate program is subject to available funding. Rebates will be distributed on a first-come, first-served basis until funding is depleted. If funds for the current funding cycle have been depleted, the qualified customer will be placed on a waiting list until the next funding cycle is approved. The District reserves the rights to terminate this program at any time, for any reason. If the program is terminated, the funding priority waiting list will also terminate and eligibility for funding for those on that list will be forfeited. e. Applicant must be in, and remain in, good standing with the District. Applicant should contact the District if they are unsure of their current account standing. f. The District is entitled to fully review all reported and material costs and reserves the right to deny reimbursement to any applicant for extraneous costs. 5. Specific Rebate Terms and Conditions a. Irrigation Efficiency Upgrades i. The maximum rebate for irrigation system efficiency upgrades is $500 per parcel. Labor costs may be included in the rebate not to exceed $150 of the rebate funding. Material cost per unit must not exceed manufacturer s suggested retail price. Installation is the sole responsibility of the applicant. However, the applicant can choose to hire a licensed (State of California C27, D12, or C36 license) landscape contractor. To confirm that a contractor holds a valid license visit www.cslb.ca.gov. In order to receive rebate funding, a detailed invoice from a licensed landscape contractor with itemized material and separate labor costs must be submitted to the District. Self installation by a residential property owner/staff will not receive reimbursement for installation costs. ii. Incidental supplies such as couplings, wire nuts, glue, tape, etc. are excluded from rebate funding. iii. Rebates will not be issued posthumously. iv. Rebates are only available to improve an existing in-ground irrigation system. New irrigation system installations are not eligible for rebates. v. Any project that is started before the Pre-Qualification Evaluation is performed is not eligible for a rebate unless the pre-qualification inspection has been waived by the Water Conservation Supervisor. Page 2 of 4
b. Clothes Washers i. The maximum rebate for new clothes washers is $75 per parcel. ii. Rebate funding shall be provided for only the cost of the unit. Incidental parts and material and installation labor costs are not eligible for rebate. iii. Only clothes washers listed on the Energy Star Most Efficient 2017 List (https://www.energystar.gov/most-efficient/me-certified-clothes-washers/) shall be eligible for a rebate. iv. Original receipts must be included with your rebate application. 1. Make and Model Number of Old Clothes Washer: / 2. Make Model Number of New Clothes Washer: / c. Pool Covers i. The maximum rebate for a pool cover is $100. ii. Pool cover shall be installed at the time of the post inspection survey in order to be eligible for rebate funding. iii. Pool covers shall be form fitted for the parcel s pool to be considered in working condition. iv. The pre-installation survey may be waived by the Water Conservation Supervisor. If the pre-installation survey is waived, a full Water-Wise House Call shall be conducted at the time of the post-inspection survey. d. Weather Based Irrigation Controllers (WBIC) i. The maximum rebate for a WBIC is $150. ii. Of the maximum rebate amount, up to $50 can be used toward labor and installation costs. iii. WBIC shall be installed and in working order at the time of the post inspection. iv. Eligible WBICs shall be EPA WaterSense Labeled Controllers only. For information regarding EPA WaterSense Labeled WBIC, visit www.epa.gov/watersense. v. Incidental supplies such as couplings, wiring, electrical tape, etc. are excluded from rebate funding. vi. WBIC weather stations shall be installed to maximize the open space above and around the unit on the uppermost eve of the building the unit is installed on. vii. The pre-installation survey may be waived by the Water Conservation Supervisor. If the pre-installation survey is waived, a full Water-Wise House Call (including irrigation system inspections) shall be conducted at the time of the post-inspection survey. e. Rain Sensor i. The maximum rebate for a rain sensor is $100. ii. The rain sensor shall be installed and in working order at the time of the post inspection. iii. Rain sensor shall be installed to maximize the open space above and around the unit on the uppermost eve of the building the unit is installed on. iv. Incidental supplies such as couplings, wiring, electrical tape, etc. are excluded from rebate funding. v. The pre-installation survey may be waived by the Water Conservation Supervisor. If the pre-installation survey is waived, a full Water-Wise House Call (including irrigation system inspections) shall be conducted at the time of the post-inspection survey. f. Toilets i. Original receipts are required to be submitted to qualify for the rebate. ii. Only toilets that have the WaterSense Certification Label shall be eligible for the rebate. iii. Pictures of both the older toilet (still installed) and new toilet (newly installed) must be provided. iv. Rebate will only be provided for the replacement of a toilet with a manufactured flush volume greater than or equal to 3.5 gallons per flush. Toilets with a manufactured maximum flush volume less than 3.5 gallons per flush are not eligible for a rebate. v. The maximum rebate amount for the single-family residential customer class is $150 per location each funding cycle. vi. The maximum rebate amount for the multi-family, commercial, industrial, and institutional customer classes is $150 per toilet with a maximum total rebate amount of $1,000 per location per funding cycle. vii. Up to $50 of the total rebate amount can be used toward installation labor costs. viii. Must be replaced with a toilet that has a maximum manufactured flush volume of 1.28 gallons per flush or less. 1. Old Toilet Manufacture Stamp Date (Year) 1 : 2. New Toilet Manufacture Name: 3. New Toilet Manufacture Model: 4. New toilet flush volume (gallons per flush) 1 The manufacture year is normally located on the inside of the tank or on the tank lid. Page 3 of 4
Federal Tax Liability Information Form The payee s Social Security or Tax ID number must be provided via a completed Form W-9 along with the rebate application in order to receive a rebate. The name on the W-9 must match the name on the rebate check. This form must be completed so the District, the rebate administer can properly complete the form 1099. This is in Compliance with the Federal Privacy Act of 1974, 42 UCS 405 (cx2xc). The Internal Revenue Service requires Rebate Program participants receiving $600 or more from the District to receive an IRS Form 1099 unless otherwise exempt. Social Security numbers provided as part of the application process are held in confidence under terms of the Privacy Act and are not divulged or otherwise conveyed to individuals or organizations outside the Rebate Program. If the total amount of your rebates (the total of all rebates received, not just one individual rebate) from the District is $600 or more in the same tax year, the District will send you a Form 1099 to comply with IRS reporting requirements. Whether your rebate is actually taxable or not may depend on several variables. You therefore should consult with your tax professional for advice on your particular situation because SSWD is not able to provide such advice. Please fill out the attached W-9 include it with your rebate application to proceed with the rebate process. Please note that only 1 (one) W-9 is required for calendar year. If you have already submitted your form W-9 to the District for another rebate opportunity, you do not have to submit another. Page 4 of 4