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2. Title II Compliance
   In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website.
6. Name*
7. Email Address

   Providing an Email address will speed up the response time to your application.

9. Address*
10. Alternate Mailing Address
    If your mailing address differs from your physical address please provide it here.
12. City*
13. State*
14. Zip Code*
16. Phone Number*
20. Are you the Property Owner?*

    1. Yes
    2. No
21. Year Home was Built*
22. Have you previously applied for this rebate?*

    1. Yes
    2. No
24. NOTE: Tenants: Participation requires written approval from property owner/property manager.
    Attach to application
25. Please indicate the date of the last rebate.
    Please indicate the date of the last rebate.
27. Where did you hear about the rebate?*
29. Reciept for new toilets*
30. Number of Toilets Replaced*
34. Rebate Information
    • The rebate value cannot exceed the actual cost of the toilet(s).
    • An original itemized dated sales receipt is required to qualify for the rebate.
    • Application must be received within 60 days of sales receipt.
    • Approval based on County record of the number of bathrooms on the property.
    • Compliance with attached guideline is required.
    • Home must be built before 1992.

38. Program Guidelines and Participation Section

    Who Qualifies?

    • City of Modesto customers who pay a water utility bill to the City of Modesto
    • Customer accounts that are in good standing
    • Tenants who provide written approval from the property owner or property manager.
    • Homes built before 1992.

    Timeline

    • Program applies to toilet(s) purchased during the current fiscal year (July 1 through June 30).
    • Rebate application must be submitted within 60 days of sales receipt.
    • The qualifying toilet must remain at the installation site for a minimum of six months after installation.

    Toilets (qualifying for rebate)

    • New toilet(s) must be rated as 1.28 gallons per flush (gpf) or less and must bear the WaterSense label.
    • View a list of qualifying toilets online or call 209-342-2246 to request.
    • Toilet(s) being replaced must exceed 1.6 gpf and be manufactured before 1992.
    • HET toilets must be installed within the Modesto City service area and at the address listed on the application.

    Rebates

    • Toilet installation, new construction, accessories, and taxes do not qualify.
    • If the existing toilet is 1.6 gallons or less per flush, they do not qualify for this rebate.
    • Rebate checks will be mailed within 8 weeks after completing the rebate process.
    • Rebate amount cannot exceed the purchase price of a new toilet(s).
    • Rebates are limited to the number of bathrooms listed on the County parcel record.

    Application and Rebate Approval or Denial

    • On-site compliance verification may be required.
    • The original itemized dated sales receipt for the new toilet is required (copies not accepted). Scanned original will be accepted via online submittal only.
    • Incomplete, incorrect or unsigned applications cannot be processed. We will contact you with any discrepancies and many require you to submit a new application.
    • Customer must fulfill all program guidelines in order to be eligible for rebates.
    • The rebate application must be submitted within 60 days of sales receipt.

    Other Considerations

    • The Rebate Program is not responsible for materials lost by mail.
    • Submissions or possession of a rebate application does not guarantee receiving a rebate application does not guarantee receiving a rebate.
    • Rebates are processed on a first come, first served basis.
    • Funding for this rebate program is limited to available resources.
    • Rebate amounts are subject to change without notification.
    • This program shall at all times be subject to change or termination without prior notice.
    • Toilets that are leased, rebuilt, rented, received from warranty or insurance claims, exchanged, won as a prize, or have had new parts installed in an existing unit do not qualify for a rebate.
42. Terms and Conditions
    The City of Modesto may deny any application that does not meet program requirements. The undersigned expressly agrees that the City may inspect all items submitted for the High Efficiency Toilet Rebate Program. The City does not guarantee the performance of any toilet; does not warrant any toilet or installation to be free of defects, the quality of the workmanship, or the suitability of the premises or the toilet for installation. The undersigned further agrees to hold harmless the City of Modesto against all loss, damage, expense and liability resulting from the loss, destruction or damage to property arising out of or in any way connected with installation of the toilet. The City reserves the right to alter this program at any time. Funding for this rebate program is limited to available resources. Rebates are processed on a first come, first served basis.
44. Electronic Signature*

    1. I have read, understand, and agree to the terms and conditions of this rebate program.
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46. Submit

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