WWW.LENEXA.COM/COSTSHARETom Jacobs • 913.477.7644

Rain barrels

STORMWATER COST SHARE APPLICATION

City of Lenexa Stormwater Management 2020 Cost Share Application

Instructions: Submit the completed application for reimbursement; please do not forget your receipts and your completed W9 form, via email to Tom Jacobs at costshare@lenexa.com or via regular post mail:

City of Lenexa Community Development Division Attn: Tom Jacobs, P.E. 17101 W. 87th Street Parkway Lenexa, KS 66219

Alternatively, you can also apply online at: www.raintorecreation.org Lenexa’s staff is here to assist you with this process. If you have questions about the program, email us at costshare@lenexa.com

Application

Applicant/Property Owner Email Address Phone Number

Address City State Zip Code

Rain Barrel Reimbursement Amount Requested: (75% of cost, up to $110 per rain barrel and associated hardware: gutter connections, diverters, leveling blocks, etc – multiple rain barrels are allowed)

By signing the application, the applicant agrees that all information provided in this application are accurate and agrees to the conditions of this program.

Applicant/Property Owner Signature Date

Applicant/Property Owner Printed Date

City of Lenexa Stormwater Management 2020 Cost Share Application MAINTENANCE & RELEASE AGREEMENT On this day of , 2020, (“Grantee”) and the City of Lenexa, Kansas, a Kansas municipal corporation (“City”) agree to the following: Grantee has voluntarily installed the following Stormwater Treatment Facility/Facilities (“STF”): 1. Provide way for grantee to mark which STFs apply.

2. Grantee agrees to maintain the above-referenced STF for a minimum of (3) years after project

completion. Nothing within this section shall limit Grantee’s responsibility to maintain its property in accordance with the Lenexa City Code.

3. Grantee understands and acknowledges that neither City’s agreement to reimburse Grantee a portion

of the cost of the STF, nor any technical advice regarding installation or maintenance of the STF shall create any responsibility for the City to maintain or manage the STF, or create any liability upon the City.

4. Grantee agrees to indemnify, defend, and hold the City harmless for any damage, loss, or liability of

any kind, including but not limited to injury to persons or damage to property which may be related to reimbursement of the cost of the STF, and/or construction of a STF on his/her property.

5. Grantee understands that the City may take photos of the STF and grants City the unrestricted right to

use and publish photographs of me and/or the STF without compensation, for editorial, trade, promotional, and any other purpose and in any manner and medium and to copyright the same. I hereby release the City from all claims and liability relating to said photographs.

GRANTEE

By:

Signature

Printed Name

Date

City of Lenexa Stormwater Management 2020 Cost Share Application

Program Conditions and Instructions

The City of Lenexa is partnering with the Johnson County Stormwater Management Program to provide $15,000 for a stormwater management cost-share program. The program is intended to help cover the cost of materials and/or contractor labor to install such projects. The City of Lenexa will provide a 75 percent match for rain barrels and associated materials, up to $110 per rain barrel. Funding is available to applicants on a first come, first served basis, and applications will be considered in the order they are received.

Lenexa staff is available to help answer any questions you have as you work through the application. If you have questions about the program, email us at costshare@lenexa.com

Program Applicant Conditions: 1. The applicant shall be responsible for all project costs. The City of Lenexa will provide reimbursement after the

costs have been incurred. After the applicant submits all final costs and receipts, the City of Lenexa will verify the structure is properly installed and will then provide reimbursement to the applicant.

2. The project must be installed and completed by October 31, 2020.

3. The City of Lenexa will require access to your property for evaluation of the application prior to the start of

construction, during construction and after construction is complete for final inspection of the project. Photos will be taken of the project for possible use in promotional materials about Lenexa’s Stormwater Program.

4. Implementation of an approved project is the sole responsibility of the property owner. The City of Lenexa is not

liable for personal injury or property damage resulting from work or alterations in drainage.

5. Projects approved for funding carry no implied warranty by the City of Lenexa.

6. The funded practice shall be maintained for a minimum period of three years. All maintenance costs are the responsibility of the property owner.

7. The applicant is responsible for obtaining all applicable permits. This includes notifying Kansas One Call

before digging. This application approval does not constitute a permit.

8. Annual reimbursement is limited to $1500 per resident.

9. The person requesting the reimbursement must submit a completed W-9 form with the application. Applications without a completed W-9 will not be approved until it has been submitted.

Form W-9(Rev. December 2014)Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

Give Form to the requester. Do not send to the IRS.

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1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

2 Business name/disregarded entity name, if different from above

3 Check appropriate box for federal tax classification; check only one of the following seven boxes:

Individual/sole proprietor or single-member LLC

C Corporation S Corporation Partnership Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶

Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for the tax classification of the single-member owner.

Other (see instructions) ▶

4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):Exempt payee code (if any)

Exemption from FATCA reporting

code (if any)(Applies to accounts maintained outside the U.S.)

5 Address (number, street, and apt. or suite no.)

6 City, state, and ZIP code

Requester’s name and address (optional)

7 List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN)Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.

Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter.

Social security number

– –

orEmployer identification number

–

Part II CertificationUnder penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3.

Sign Here

Signature of U.S. person ▶ Date ▶

General InstructionsSection references are to the Internal Revenue Code unless otherwise noted.

Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) is at www.irs.gov/fw9.

Purpose of FormAn individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following:

• Form 1099-INT (interest earned or paid)

• Form 1099-DIV (dividends, including those from stocks or mutual funds)

• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)

• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)

• Form 1099-S (proceeds from real estate transactions)

• Form 1099-K (merchant card and third party network transactions)

• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)

• Form 1099-C (canceled debt)

• Form 1099-A (acquisition or abandonment of secured property)

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.

If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2.

By signing the filled-out form, you:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and

4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information.

Cat. No. 10231X Form W-9 (Rev. 12-2014)

Frequently asked Questions What Items are reimbursable? Each project needs to be evaluated individually, but there are some common items that qualify for reimbursement and others that typically don’t:

Can I get reimbursed for labor? Yes. You can be reimbursed for labor if you hire a professional landscaper to do the installation for you. You will need to submit the receipt for reimbursement. Reimbursement for labor is not allowed if you do the work yourself.

Can I be reimbursed for more than one rain barrel? Yes. You can be reimbursed 75% for each rain barrel up to a total reimbursement of $1,500.00 I participated in the program last year. Can I participate again this year? Yes.

Can I get reimbursed to replace street trees? No. the City has a separate cost share program for that purpose. Contact Curt Talken (ctalken@lenexa.com) or Danny Huntsinger (dhuntsinger@lenexa.com) to verify that you are eligible for the program and for preapproval of the replacement tree species.

Can I use some non-native plants in my garden? Yes; however, the reimbursement of all materials will be reduced by the percentage of non-native plants that are used.

Reimbursable

•Rain barrels and cisterns•Native plants and native trees•Permeable Pavers•Minor fencing to keep pests away that may

damage your plants. Rabbits, dogs, etc•Edging to keep turf grass from spreading to

the planting area•Soil amendments such as compost•Mulch•Rock if associated with erosion control or

storage•Gutter connections and diverters for rain

barrels•Blocks or other elevated platform for rain

barrels

Not Reimbursable

•Materials for raised beds (such as timbers)•Edging that is for aesthetics only•Boulders and other hardscape•Bird feeders, etc•Butterfly stations•Non-native plants