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2. 
4. Please select the service type and complete the required fields marked with an asterisk (*).*

   I want to...

   1. Start service at a Residence as the Property Owner (WS28RO)
   2. Start service at a Residence as a Tenant (WS-28RT)
   3. Start service at a Commercial Property as the Property Owner - $250 deposit required (WS-28CO)
   4. Start service at a Commercial Property as a Tenant - $250 deposit required (WS-28CT)
6. Coachella Valley Water District’s Domestic Water Rates
   Click here for more information about Domestic Water Rates
8. Date to Start Service*
   Date to Start Service
   • Date to start service should be within the next two weeks.  Requests for a later date may be rejected or held for processing
   • We are unable to start service for a past date
   • The request of a service date does not guarantee a date of service
10. Establishment Fee*

    1. I understand a $46 Account Establishment Fee will appear on my first bill

    
    

    New Service Fee

    • $0 - Turn on next business day or later between 8:00 a.m. and 5:00 p.m. weekdays (excluding holidays)
    • * $52 - Turn on today between 8:00 a.m. and 3:00 p.m. weekdays (excluding holidays)
    • * $126 - Turn on between 3:00 p.m. and 10:00 p.m. all weekdays (excluding holidays)
    • * $252- Turn on between 5:00 p.m. and 8:00 a.m. weekdays, all day weekends and holidays

    * Please call Customer Service at (760) 391-9600 after submitting this request to confirm any of the last three options

12. Service Address Line 1*
14. Service Address Line 2
16. City*
    -- Select One --Cathedral CityDesert Hot SpringsIndian WellsIndioLa QuintaMeccaNilandPalm DesertRancho MirageSalton CitySky ValleyThermalThousand Palms

    If your city is not listed, your water service is provided by another district or agency (Desert Water Agency, City of Coachella, Indio Water Authority, Myoma Dunes, Mission Springs Water District)

17. Zip Code*
19. Property Owner First Name*
20. Property Owner Last Name*
22. Tenant First Name*
23. Tenant Last Name*
25. Secondary Applicant First Name
26. Secondary Applicant Last Name
28. Realtors

    1. Click here if you are Realtor representing this property.

    Complete the request to start service as a property owner and provide a listing agreement designating that you are the authorized agent for the property owner and are responsible for the water at the property. A $100 deposit is required to establish service. Under some circumstances, a hold harmless agreement may be required for third parties.

30. Listing Agreement*
32. First Name*
33. Last Name*
35. Telephone Number*
36. Email Address*
38. Listing Agreement*
40. Assessor's Parcel Number, if known
41. Lot Number, if known
43. Service is for:*

    1. Domestic
    2. Irrigation

    1. Fire Protection
    2. Sewer
45. Type of Business*
47. Business Name*
49. Business Hours
    Business Hours Start Time

    —

    Business Hours End Time
51. Previous or Current CVWD Service Address
53. Previous or Current CVWD Service Start and End Dates
    Previous or Current CVWD Service Start and End Dates Start Date

    —

    Previous or Current CVWD Service Start and End Dates End Date
55. Mail my bill to:*
    -- Select One --The property addressA different address
57. Mailing Address Line 1*
59. Mailing Address Line 2
61. City*
62. State or Province*
63. Zip or Postal Code*
65. Primary Telephone Number*
66. Primary Telephone Number Type*

    1. Cell phone
    2. Home
    3. Work
68. Secondary Telephone Number
69. Secondary Telephone Number Type

    1. Cell phone
    2. Home
    3. Work
71. Email Address*
73. Property Owner / Landlord First Name*
74. Property Owner / Landlord Last Name*
76. Property Owner / Landlord Phone Number*
77. Landlord Type*

    1. Property Owner
    2. HOA
    3. Property Manager
79. Emergency Contact / Authorized Agent Name*

    Person authorized to access your account information and act on your behalf. Please input "None" if no one is authorized.

81. Emergency Contact / Authorized Agent Telephone
82. Emergency Contact / Authorized Agent Email Address
84. Authorization for Tenants to Establish Service*

    As the Property Owner, do you authorize current and future tenant(s) to establish service in their name?

    1. Yes, I authorize a tenant to establish service in their name. I understand that a tenant will be required to submit their request to start service.
    2. No, I do not authorize a tenant to establish service in their name. This account will be held in the property owner's name only.
86. Affidavit of Ownership*

    I / We acknowledge ownership of property located at the service address entered. I declare under penalty of perjury and possible immediate discontinuance of water service that I assumed or will assume ownership of said property upon closure of escrow (or through other legal acquisition) on the date I provided in this application. Further, I acknowledge that as the owner of the aforementioned property, I ultimately assume all responsibility for any bills, costs or fees associated with water service, regardless of user or use.

    1. I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Affidavit of Ownership.
88. Responsibility for Payment of Water Bills*

    Property Owners are responsible for payment of water bills.

    By acknowledging this document, I certify I am the legal landowner or designee of the property identified as the service address above, all information is true and correct, and acknowledge and agree to all terms and conditions set forth below. I assume all responsibility for any bills, costs, loss, damage, penalties, charges, or fees associated with water service regardless of user or use.

    Owners may authorize tenants to establish service in their names; however, responsibility for the account remains with the Property Owner. The District, as a courtesy, may allow the Property Owner to authorize a Tenant to be billed for service. This courtesy is at the discretion of the District and as such, the District may transfer service from a Tenant back to the Property Owner and refuse to allow future service to be billed to a Tenant. In such circumstances, the Property Owner will receive all billing statements. CVWD may require Property Owners to pay any outstanding balances prior to a new Tenant establishing service. Upon termination of the tenant’s account, the account will automatically revert to the owner’s name.

    I understand all bills are due and payable within 15 days of billing. Bills not paid within 25 days of billing are assessed a 1.5% Late Charge. Bills not paid within 40 days of billing are assessed a $25 Delinquency Fee. I understand a $46 Account Establishment Fee will appear on my first bill.

    1. I acknowledge and agree to comply with all District Regulations, Ordinances, Policies and Rules, or amendments thereto.
90. Responsibility for Payment of Water Bills *

    By acknowledging this document, I certify I am the authorized tenant of the property identified at the service address above, all information is true and correct, and I acknowledge and agree to all terms and conditions set forth below. Upon termination of my account, the account will automatically revert to the owner’s name. I understand all bills are due and payable within 15 days of billing. Bills not paid within 25 days of billing are assessed a 1.5% Late Charge. Bills not paid within 40 days of billing are assessed a $25 Delinquency Fee. A $46 Account Establishment Fee will appear on the first bill. The District may transfer service from a Tenant back to the Property Owner and refuse to allow future service to be billed to a Tenant. In such circumstances, the Property Owner will receive all billing statements.

    1. I acknowledge and agree to comply with all District Regulations, Ordinances, Policies and Rules, or amendments thereto.

92. Terms & Conditions

    
    

    CVWD owns, operates, and maintains the portion of the line from the water main to the outlet of the gate valve on the downstream side of the meter, check valve or backflow prevention device (Service Connection). Customer is responsible for the remaining portion of the line to the property being served (Customer Service Line). The Customer Service Line includes separate domestic water and fire sprinkler systems.

    
    

    Customer acknowledges that CVWD will provide a single Service Connection to Customer’s property identified in this application (Property). CVWD may discontinue service to the Property for any reason set forth in the Regulations, including, but not limited to, failure to make payment when due. If CVWD discontinues service, there is no water for the property sprinkler system. Customer assumes all risk of loss and damage to the Property or injury arising out of the termination of service and waives all claims against CVWD, including losses in connection with the loss of property fire sprinkler protection. Customer assumes all risk of loss or damage to personal and real property due to backflow from the fire sprinkler system portion of the Customer Service Line into the domestic portion of the Customer Service Line for any reason whatsoever, including without limitation, any water quality exceedances.

    
    

    Customer shall assume the defense of, indemnify and hold harmless CVWD from and against all actions, causes of action, damages, demands, liabilities, costs (including, but not limited to reasonable attorneys’ fees), claims, losses and expenses of every type and description (collectively, Costs) to which it may be subjected resulting from: (A) the design, construction, testing (including inspection to ensure that such system is operational), operation, maintenance, repair and replacement of the property fire sprinkler system located on the Property; (B) the performance of, or the failure of performance of, the residential fire sprinkler system; (C) backflow from the fire sprinkler system portion of the Customer Service Line into the domestic portion of the Customer Service Line for any reason whatsoever, including without limitation, any water quality exceedances; and (D) any death, injury, property damage, accident or casualty caused or claimed to be caused by the discontinuance of service to the Property for any reason set forth in CVWD’s Regulations, including, but not limited to, failure to make payment when due, including any Costs in connection with the loss of the use of the property fire sprinkler system. CVWD shall make all decisions with respect to its representation in any legal proceeding concerning this section.

    
    

    Service is subject to the requirements and limitations set forth in the Regulations of the District, as they may be changed from time to time.

94. By typing or signing my name, I certify that I understand the terms and conditions outlined above and that to the best of my knowledge the information I provided is true and correct.*

96. COACHELLA VALLEY WATER DISTRICT
    Post Office Box 1058
    Coachella, California 92236
    (760) 391-9600
    (760) 398-3190 - fax
    CustomerService@cvwd.org

    rev 6/2022

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97. 1. Receive an email copy of this form.
98. Email address

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