[City of Sacramento] Toilet Rebate Application

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Toilet Rebate Application

The Toilet Rebate is for the City of Sacramento Department of Utilities water customers to purchase and install new water efficient toilet(s). The customer must be replacing toilet(s) using 3.5 gallons per flush (gpf) or greater. The toilet to be replaced must have been installed prior to 1992.

To obtain a rebate, customers are required to complete a pre-inspection before the old (PRE-1992) toilet is removed.

Applicant Name

Rebate Check Payable To

Is your Mailing Address different from property Address?

Yes

Important: This is where DOU will mail the final rebate check

Phone Number

Water Account Number

Assessor's Parcel Number

To be eligible, you must:

Be receiving City of Sacramento water service at the property;
Be the property owner or bill-paying tenant with written consent from the property owner.

High Efficiency Toilet (HET) Requirements:

A HET uses 1.28 gallons per flush or less.
Replacement of an Ultra Low Flush toilet (toilet purchased between 1992-2013 that flushes 1.6 gallons per flush) with a HET is not eligible under this program; neither is replacement of a HET with another HET eligible.
New construction is not eligible for rebate under this program.
You may install the toilet(s) yourself or you may also hire a contractor or plumber.

NOTE: Building permits are not required when a residential customer simply removes and installs a toilet on existing plumbing. A permit is required when a plumbing fixture will be relocated or you are a commercial customer.

Type of Property

Single Family or Duplex

Institutional

Commercial

Industrial

Government

Multi-Family (HOA, Apartment or Condo Complex)

Rebate Amount:

Maximum rebate amount for residential HET is $125 per toilet.
Total Rebate amount will not exceed money spent by the customer.
Eligible expenses include tank, bowl and tax.
Installation and items needed for installation are not eligible expenses.

Rebate Amount:

Maximum rebate amount for commercial gravity style toilet is $150 per toilet and $250 for commercial flushometer type toilets.
Total Rebate amount will not exceed money spent by the customer.
Eligible expenses include tank, bowl and tax. For commercial installation, both the tank (when applicable), bowl and flushometer must be replaced.
Installation and items needed for installation are not eligible expenses.

Rebate Amount:

Maximum rebate amount for commercial gravity style toilet is $150 per toilet and $250 for commercial flushometer type toilets.
Total Rebate amount will not exceed money spent by the customer.
Eligible expenses include tank, bowl and tax. For commercial installation, both the tank (when applicable), bowl and flushometer must be replaced.
Installation and items needed for installation are not eligible expenses.

Rebate Amount:

Maximum rebate amount for commercial gravity style toilet is $150 per toilet and $250 for commercial flushometer type toilets.
Total Rebate amount will not exceed money spent by the customer.
Eligible expenses include tank, bowl and tax. For commercial installation, both the tank (when applicable), bowl and flushometer must be replaced.
Installation and items needed for installation are not eligible expenses.

Rebate Amount:

Maximum rebate amount for commercial gravity style toilet is $150 per toilet and $250 for commercial flushometer type toilets.
Total Rebate amount will not exceed money spent by the customer.
Eligible expenses include tank, bowl and tax. For commercial installation, both the tank (when applicable), bowl and flushometer must be replaced.
Installation and items needed for installation are not eligible expenses.

Rebate Amount:

Maximum rebate amount for commercial gravity style toilet is $150 per toilet and $250 for commercial flushometer type toilets.
Total Rebate amount will not exceed money spent by the customer.
Eligible expenses include tank, bowl and tax. For commercial installation, both the tank (when applicable), bowl and flushometer must be replaced.
Installation and items needed for installation are not eligible expenses.

Who is completing this application?

Property Owner

Property Manager

Other

Please Specify

Does the Rebate amount sum exceed more than $600?

Yes

FED. Tax Identification (ID)

Company Name (Business Only)

Property/Site Name (If applicable)

Date Toilet(s) Installed

Before 1992

After 1992

Not Sure

Number of Toilets on property

Number of Toilets for Rebate

Please upload photo(s) of your existing toilet with the GPF (gallons per flush) information.

Click Here to Upload

Note: The manufacturer’s name and a “gpf” label often appear right behind the seat hinge on the bowl. If you don’t see a gpf label, lift the tank lid and check the inside back of the toilet tank for the manufacturer’s date stamp—it is usually stamped directly into the porcelain.

Are you the water bill recipient for the account number listed above?

Yes

Please provide the name and phone number of the water bill recipient.

Water Bill Recipient Name

Phone Number

How did you first hear about the City's Rebate Programs:

Please Specify

Program Checklist

Toilet Rebate Terms & Conditions

Terms & Conditions Confirmation.

By checking box, I acknowledge that I have read and understand the program Terms and Conditions.

I understand that I must have a pre-inspection before the old (Pre-1992) toilet is removed.

By checking box, I confirm.

I understand that if I am asked for supplemental documents to my application, I must supply them within two weeks from the time I am asked for them from program staff.

By checking box, I confirm.

I understand that the City of Sacramento is required to send IRS form 1099 to me and the IRS when rebates total $600 or more.

By checking box, I confirm.

I understand that I must provide the original dated receipt and/or plumbers invoice with the price, model and brand of each toilet listed individually after completion of the project to receive the rebate.

By checking box, I confirm.

Steps to proceed:

Submit a completed Toilet Rebate application.
Wait for approval from Water Conservation staff. Please note that missing information may cause a delay.
Complete your toilet installation, submit original dated receipt(s) and/or plumber invoice and photos of the new installed toilet(s). Keep copies for your records.
Receive a rebate check-It may take up to 12 weeks to receive your check in the mail.

Rebate Agreement - Release of Liability:

I have read and understand the program information as stated in the attached application materials. I certify that I have installed the above identified toilet(s) at the above-identified property. I also understand that by signing here I agree to have an official of my water provider verify the installation of the toilet(s) at the property. I agree to defend, indemnify and hold harmless the City of Sacramento, Sacramento Regional County Sanitation District (SRCSD), the Regional Water Authority (RWA), and their respective officers, employees, agents and contractors against and from any and all liability or claims for damage or other costs arising or alleged to arise from the installation of the toilet(s), the inspection of the premises to verify proper installation, or any other activity or failure to act related to this program. The City of Sacramento, the RWA and the SRCSD reserve the right to deny an application of any participants who does not all meet requirements as outlined; reserve the right to change the terms of this program at their discretion and are not responsible for the lost receipts or paper work. The agency cannot guarantee that the installation of the HET(s) will result in lower water utility costs.

Signature

First Name

Last Name

Choose how to sign

Draw Type

By signing above, you agree to Rebate Agreement and thereby certifying that you have read, understand, and agree to the Rebate Agreement Release of Liability and the Terms and Conditions of this Program.

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