RainSmart Rebates Reimbursement Request Form

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Applicant's Information

Are you the homeowner?

YesNo

Thank you for your interest in RainSmart Rebates.

Unfortunately, we can only accept Reimbursement Request Forms and Property Owner Agreements submitted and signed by the homeowner. Please have the homeowner initiate and complete the Reimbursement Request Form and Property Owner Agreement or visit www.oakgov.com/rainsmart for more information.”

Checks will be made out to the name listed and sent to the address indicated below:

First Name

Last Name

Street Address

Address Line 2

City

State

Zip Code

Site ID

The Site ID can be found on your Site Assessment Report.

Agreement

RainSmart Rebates Program Property Owner Agreement

This Agreement establishes an understanding between the GWK and the Property Owner regarding the terms and conditions governing the Property Owner’s participation in the RainSmart Rebates Program, the (“Program”).

Terms and Conditions

In consideration of their mutual promises and commitments, the GWK and the Property Owner agree as follows:

1. Property Owner grants designated agents of the GWK and/or the Clinton River Watershed Council (“CRWC”) reasonable access to the property at a reasonable time arranged in advance by mutual agreement to:

evaluate the property as an appropriate site for the planting of not more than two (2) trees at a cost of not more than $250 apiece, the placement of not more than two (2) rain barrels at a cost of not more than $125 apiece, or the installation of a rain garden the cost of which shall not exceed two thousand dollars ($2,000);
inspect the final installation and/or plantings to determine that it meets Program standards;
monitor and gauge the maintenance and performance of the provided plantings, rain barrel or other material to ensure that it satisfies the purpose of the Program.

2. Property Owner, in consultation with the CRWC and/or a GWK representative, is responsible for choosing the appropriate location to ensure proper water conveyance, drainage, and the avoidance of any utility conflicts.

3. During the term of this Agreement, Property Owner will operate and maintain the infrastructure in accordance with the recommendations and guidance provided by the CRWC and/or the GWK and will exercise reasonable care to avoid interference with, damage to, or loss of function of the infrastructure.

4 Property Owner, by participating in this Program, assumes the risk and agrees to hold harmless the GWK, its agents, officers, directors, employees, and any other person(s) acting on its behalf, from any liability or damages or injuries resulting from its participation this the Program or for any claim(s) relating to the installation and operation of the infrastructure.

5. This Agreement is effective as of the date entered above and will expire five (5) years after the final inspection and sign-off by the GWK.

6. Property owner grants the GWK and/or the CRWC the right to photograph or videotape the installations of the infrastructure and to publish such photographs or video for promotional and/or educational purposes.

7. All written notices or reports required under this Agreement shall be provided by posting in first-class mail as follows to:

George W. Kuhn Drain Drainage District
1 Public Works Drive
Waterford, Michigan 48328-1907

Property Owner Agreement

By checking this box, I state that I have read and understand the terms and conditions of the Property Owner Agreement

By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.

Project Types

Project Type(s)

Please check all stormwater projects that were installed

Rain GardenRain BarrelTree

You will be required to enter an itemized list for each project, submit photos and attach a copy of your receipts. This form can upload up to 30mb. If you have more than eight photos, please reduce their size before submitting the form.
Properties that install more than one stormwater project will be eligible to receive the maximum rebate amount available per project up to the maximum $2,000/property.

Rain Garden

Rain Gardens will be reimbursed up to $6/square feet or the total project cost, whichever is less.

Installation:

Do It Yourself (DIY)ContractorBoth

Date the Rain Garden project was completed

Total Area square feet	Depth inches	Total Volume (cubic feet) This field is auto-calculated from Area and Depth
Maximum Eligible Rain Garden Reimbursement Amount (Area multiplied by $6 per square foot) $ Auto-calculated

Rain Garden Itemized Cost List

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Rain Garden Reimbursement Summary

Rain Garden Costs Subtotal

Auto-calculated

MI Sales Tax

Auto-calculated

Total Rain Garden Reimbursement Request

Auto-calculated

If there is a discrepancy in the amount calculated and the total amount requested, the final rebate amount will be based on the receipts submitted up to the eligible rebate amount.

Photos of your Rain Garden project

Please review the photo documentation guidance.

Itemized Rain Garden receipts, cancelled checks, and invoices.

Please Note:

This form can upload up to 30mb. If you have more than eight photos, please reduce their size before submitting the form.
All photos will become property of the Oakland County Water Resources Commissioner’s Office with the right to use in promotional materials.

Rain Barrel

Rain Barrels will be reimbursed up to $125 per installation or the total project cost, whichever is less. Up to two rain barrel installations are eligible per property.

Number of Rain Barrels Installed

One Rain Barrel installed ($125 max reimbursement)Two Rain Barrels installed ($250 max reimbursement)

Installation:

Do It Yourself (DIY)ContractorBoth

Gallons/barrel #1

Gallons/barrel #2

Date the Rain Barrel project was completed

Rain Barrel Itemized Cost List

Vendor	Item	Qty	Unit Cost	Total
			$	$
			$	$
			$	$
			$	$
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Rain Barrel Reimbursement Summary

Rain Barrel Costs Subtotal

Auto-calculated

MI Sales Tax

Auto-calculated

Total Rain Barrel Reimbursement Request

Auto-calculated

If there is a discrepancy in the amount calculated and the total amount requested, the final rebate amount will be based on the receipts submitted up to the eligible rebate amount.

Photos of your Rain Barrel project

Please review the photo documentation guidance.

Itemized Rain Barrel receipts, cancelled checks, and invoices.

Please Note:

This form can upload up to 30mb. If you have more than eight photos, please reduce their size before submitting the form.
All photos will become property of the Oakland County Water Resources Commissioner’s Office with the right to use in promotional materials.

Tree

Trees will be reimbursed up to $250/tree or the total project cost, whichever is less. Up to two tree plantings are eligible per property.

The purchased and planted tree(s) must be on the RainSmart Rebates Eligible Tree Species List.

Number of Trees Planted:

One Tree Planted ($250 max reimbursement)Two Trees Planted ($500 max reimbursement)

Tree #1 Height (feet):

Tree #1 Caliper (inches):

This is the diameter of the tree's trunk at breast height

Tree #1 Species (Example: Red Maple, Acer Rubrum):

Tree #2 Height (feet):

Tree #2 Caliper (inches):

This is the diameter of the tree's trunk at breast height

Tree #2 Species (Example: Red Maple, Acer Rubrum):

Date Tree project was completed:

Installation:

Do It Yourself (DIY)ContractorBoth

Tree(s) Itemized Cost List

Vendor	Item	Qty	Unit Cost	Total
			$	$
			$	$
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			$	$

Tree Reimbursement Summary

Tree Costs Subtotal

Auto-calculated

MI Sales Tax

Auto-calculated

Total Tree Reimbursement Request

Auto-calculated

If there is a discrepancy in the amount calculated and the total amount requested, the final rebate amount will be based on the receipts submitted up to the eligible rebate amount.

Photos of Tree project

Please review the photo documentation guidance.

Itemized Tree receipts, cancelled checks, and invoices.

Please Note:

This form can upload up to 30mb. If you have more than eight photos, please reduce their size before submitting the form.
All photos will become property of the Oakland County Water Resources Commissioner’s Office with the right to use in promotional materials.

Total Request

Total amount being requested from RainSmart Rebates

This field is auto-calculated.

All requests will be reviewed by RainSmart Rebates staff and compared against the receipts submitted. Upon completion of the review, you will receive an email that will either confirm the submitted amount, request additional information, or identify the actual eligible rebate amount.

Survey Information

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I heard about RainSmart Rebates from:

Would you be willing to provide a testimonial about your experience with RainSmart Rebates?

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Do you have any comments about the program or your experience?

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