Residential Waterwise Landscaping Rebate

Application FormPLEASE NOTE: YOU MUST HAVE YOUR WATERWISE LANDSCAPE PROJECT PRE-APPROVED BEFORE YOU APPLY

CALL (951) 826-5485 FOR CONFIRMATION BEFORE BEGINNING YOUR PROJECT.

Once project is complete, use the form below to fill in your account information and information about your project. Then PRINT THE FORM, SIGN IT, and submit it with all applicable receipt copies to:

Riverside Public Utilities - Programs & Services - 3750 University Ave. - 3rd Floor - Riverside, CA 92501

Failure to provide complete customer information, signature(s), model numbers, or receipt copies may result in processing delays. Please allow 8-12 weeks for processing.

Name on Utility Account Account #

Zip CodeInstallation Address Phone

Mailing Address (If different)

Customer Information

I certify that I am the owner(s) or tenant(s) of the real property where the improvements have been installed and that I have not previously received, or applied for, other utility financing or incentives for the improvements on this application. I also certify that the foregoing information is true and correct. I understand and agree that the choice of improvements, the selection of contractors, the purchase of items and acceptance of materials used and work performed and the payments thereof is my responsibility. I understand that I will be fully liable for any damage to person or property that may be caused by the installation and/or operation of the equipment involved. I understand that Riverside Public Utilities does not endorse, recommend or make any representations as to specific brands, products, contractors or dealers nor does it guarantee material or workmanship. I further agree to indemnify and hold harmless the City of Riverside, its officers, employees, and agents from any damages related to the installation of the waterwise landscaping.

Signature of Applicant __________________________________ Date __________

Signature of Owner _____________________________________ Date _________ (If Applicant is renter or tenant)

FOR OFFICE USE ONLY

JL Key 6220209080 Object 45701100 Rebate Amount

Certification of Delivery Approved for Payment Approved for Payment

Signature Date Department Head Date Finance Department Date

RPU Inspector Information: Date Inspected ______________ By __________________________ Notes __________________________________________________ ___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________

Waterwise Landscaping InformationSquare feet of turf area removed

(must be a minimum of 500 square feet)Square feet of plant cover required (A, divided by 4)

A. B.

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