2007/2008 City of Roseville Water Efficiency Benchmarking Rebate Programfor New Single Family Homes Eligibility The City of Roseville water use efficiency rebates are available to builders constructing new single-family residential homes within the City of Roseville water utility service territory. Water service must be provided by the City of Roseville to be eligible for the rebate and homes must be newly constructed and unoccupied at the time of application for the rebate. This program has a limited budget. Applications will be accepted on a first-come, first-served basis until allocated funds are depleted. The City of Roseville reserves the right to redirect rebate funds to other incentive programs as necessary. Terms and Conditions I have read and understand the Water Efficiency Benchmarking Rebate Program (Program) requirements set forth in this application form, and I agree to abide by these requirements. I have attached the required documentation and certify that the information provided on this application is true and correct. I certify that I have purchased and installed the indicated water use efficiency products listed on this application at the stated address and that all equipment installed is new and in good working order. I agree that the selection, purchase, ownership and maintenance of the equipment is my sole and exclusive responsibility. The City of Roseville makes no representation as to the safety, reliability, and/or efficiency of the equipment selected to meet the programs intent or to perform as intended. I understand that any tax consequences arising from participation in the Program is my exclusive obligation and responsibility, and that I have been advised by the City of Roseville to consult with a tax advisor prior to participation in the Program. I expressly understand and agree that the City of Roseville is not responsible for any taxes that may be imposed on my business as a result of my receipt of this rebate. _____________________________________________________________________________ Customer Signature Date _____________________________________________________________________________ Print Name _____________________________________________________________________________ Company Name 1 Feature High Efficiency Toilets (HET) Faucet Aerators Low-flow showerheads h-axis clothes washer Energy Star dishwasher Smart irrigation controller Performance Requirement Performance Specification and/or Reference 1.28 gallons per flush (average) EPA WaterSense draft HET spec Bath: 1.5 gpm @60 psi Kitchen: 2.2 gpm @60 psi Builder option Single head using 1.6 gpm or less Builder option (e.g. Delta H20 Kinetics, with “satisfactory” wetting Bricor, Niagara) performance Water factor (WF) of 7.5 or less Consortium for Energy Efficiency rating Tier 3A (http://wwwcee1.org/resid/seha/rwsh/r eswash_specs.pdf) Discounts/donations are being solicited 6.5 gal/cycle or less Energy Star rating. See State of Oregon listings: http://Oregon.gov/ENERGY/CONS/RE S/tax/appdish.shtml Devices with published SWAT Based on SWAT performance criteria: testing results presumed http://www.irrigation.org/gov/default.as acceptable; others on a case by px?pg=swat_intro.htm&id=105 case basis Discounts/donations are being solicited Table 1: Minimum specifications for high efficiency homes The City of Roseville is one of nine agencies participating in a national research study sponsored by the US Environmental Protection Agency (EPA). The goal is to determine if advanced technologies in new homes reduce water demand. The study will evaluate how “standard” new homes compare to “high efficiency” new homes in regards to water use. The last national study of this kind was conducted in 1999 after the plumbing standards changed. This program is open to builders who are constructing new high efficiency homes within the City of Roseville water utility service territory to include advanced water saving technologies. Each home constructed that incorporates all features specified in Table 1 are eligible to receive a $1,500 rebate per home from the City of Roseville. The program target is to rebate 20 new homes. Builders participating in this study will be nationally and locally recognized in various publications and formats. The City of Roseville is working to secure equipment donations or significant manufacture price reductions on Smart Irrigation Controllers and high efficiency washer/dryer sets. Contact (916) 746-1710 for status information prior to purchase. 2 Feature Make Model # installed Date of Install For internal use only Inspection Inspector Date Name High Efficiency Toilets Bath Aerators Kitchen Aerators Low-flow showerheads h-axis clothes washer Energy Star dishwasher Smart irrigation controller Installation Verification Worksheet Customer Information _____________________________________________________________________________ Name of Company or Owner ____________________________________________________________________________ Address where items were installed City State Zip _____________________________________________________________________________ Address of Company or Owner City State Zip _____________________________________________________________________________ Name of Contact Person Phone Fax Minimum specification must be achieved for rebate eligibility. How to Apply 1. 2. 3. 4. 5. Contact the City of Roseville Water Conservation Division at (916) 746-1710 to confirm rebates are still available and to receive the latest product information. Purchase and install all features listed in Table 1. Schedule a verification inspection with City of Roseville staff. Complete the Installation Verification Worksheet and include manufacturer receipts for fixtures installed Submit the Worksheet with receipts attached along with the Terms and Conditions acceptance form to: City of Roseville Environmental Utilities Attn: Lisa Amaral 2005 Hilltop Circle Roseville, CA 95747 3 Requirements Purchased equipment must meet the specified requirements listed in Table 1 of this application form. If you have questions, contact (916) 746-1710 to confirm eligibility before specifying or purchasing products. The City reserves the right to withhold payment for systems that do not meet the requirements. All equipment must be new. Used or rebuilt equipment is not eligible. Customers installing the features specified in Table 1 are eligible to receive $1,500 per residential household in which these products were installed. Request for payment must be submitted and finalized within 3 months of product installation. Manufacturer documentation including make and model of each fixture installed is required. The customer agrees to a mandatory project inspection by City of Roseville staff, or their designated representative, upon notification that all efficiency measures have been installed. If requested by the builder, Roseville staff will meet with the home buyer to review each water efficiency fixture installed. 4