Form Section 1

Translate

Commercial Adjustment Form

It is the sole responsibility of the customer to contact the District to request an adjustment of their water bill through the Commercial Adjustment Form. Customers must complete the Adjustment Form within one (1) month of their affected bill.

All bill adjustment requests will be determined on a case-by-case basis. Only one bill may be adjusted per qualifying event. The District may adjust either the most recent bill or the higher of the two most recent affected bills.

To be eligible for an adjustment of charges, the customer's water usage must be entirely within their water budget (Tiers 1 & 2) within two (2) billing periods following the repair or resolution date of the qualifying event.

Customers must keep accounts in good standing to avoid incurring any additional fees or charges. It is the responsibility of the customer to contact the Billing Department to make any payment arrangements if payment cannot be made in full at the time payment is due.

Billed units in Tiers 3 and 4 will be recalculated at the Tier 2 rate for the adjustment. Any approved adjustment will be issued as a credit on a future water bill. Checks will not be issued.

Customer Information

Business or HOA Account Name

Phone Number

Account Number

Service Address Street Number and Name

City

Zip Code

Form Section 2

Adjustment of Charges

Adjustment requests must be submitted within one (1) month of the affected bill, and adjustments will be made only to the most recent bill. If approved, consumption in Tiers 4 and 5 will be adjusted to the Tier 3 rate. All bill adjustments will be made in the form of a credit to the customer's account. Checks will not be issued.

Leak Repairs

Pools (Permitted once every five years) Spas and ponds not eligible. Submit after affected water bill is received.

New California Friendly Landscapes* (Variance is awarded between November and April)

Other* (For incidents not listed above)

Select date of leak repair

Describe the repair

Attach a copy of any receipts, invoices, or documentation for the work performed

Date of pool fill

Pool Dimensions: Width (ft)

Pool Dimensions: Length (ft)

Pool Dimensions: Average Depth (ft)

Approximate Total Gallons (Width [ft] x Length [ft] x Depth [ft] x 7.48 [gal/cu. ft.])

Describe the repair and/or reason for pool fill

Attach a copy of any receipts, invoices, or documentation for the work performed. For pool fills associated with water quality issues, no adjustments will be made

Describe the landscaping work performed and plant material used

Attach a copy of any receipts, paid invoices, or documentation for the work performed and/or new plant material

Incident (Enter N/A if not applicable)

Provide any details regarding your request for an adjustment

As a public agency it is necessary to produce auditable documentation. Please attach a copy of any receipts, paid invoices, or documentation for the work performed

Acknowledgement of Terms and Conditions

It is the responsibility of the customer to contact the District and request adjustments to their base allocation through a Residential Variance or Residential Adjustment Form. Any customers providing falsified information to the District may be liable for back charges. Bill calculations based on falsified information will be recalculated with corrected customer account details.

I affirm that the information contained herein, including attachments, is complete and accurate. I understand that all variances and adjustments are subject to change based on future water conservation requirements.

I agree.

Sign Here

First Name

Last Name

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.