Program Rules
• Appliances must be for use at a Fort Collins Utilities
service address.
• Toilet, showerhead and sprinkler rebates are
for Fort Collins Utilities water customers only.
Stormwater and wastewater only accounts,
including ELCO and Fort Collins-Loveland Water
District customers, are not eligible.
• Limit of two toilets, two showerheads, one clothes
washer, one dishwasher and one of each sprinkler
category per year.
• P urchases for rebates must be between Jan. 1,
2016, and Dec. 31, 2016. Submit application by Jan.
15, 2017.
• Verification of toilet recycling must be on
application or by voucher.
• A copy of the itemized receipt must include model
number, purchase price and date of purchase.
• New construction appliance upgrades must be
verified by signed price sheet from builder.
• Fort Collins Utilities reserves the right to verify the
purchase and installation location.
• Rebate program is subject to available funds.
• Allow eight weeks for bill credit processing.
• Rebate not to exceed purchase price. Bill credit will
be rounded down to the nearest dollar.
Where Did You Hear about
the Rebate Programs?
Bill insert
Retailer
Utilities website
Media (newspaper, radio)
Friend/family member
Social media
Lose-A-Watt Initiative
Event ____________________________
Other ____________________________
Toilet Rebates –
Recycling Required
Get a Bill Credit in
Three Easy Steps
Recycling center staff must sign the toilet
recycling verification below. If you don’t have the
application with you, the recycler will give you a
signed voucher. All metal and plastic parts must
be removed.
1. Purchase and install qualified fixtures or
appliances according to program rules
Number of toilets recycled
3. Sign and return completed application
form, copy of your sales receipt and any
toilet recycling verifications to:
1 2
Date
Authorized signature
Print name
Home
2. Recycle old toilet(s) and obtain toilet
recycling verification, if applicable
Fort Collins Utilities
2016 Conservation
Rebate Application
Fort Collins Utilities
Customer Service Division
Home Conservation Rebates
P.O. Box 580
Fort Collins, CO 80522
or
Scan and email application and
receipt to [email protected]
Recycle at
City Streets Facility
1380 Hoffman Mill Rd.
(east side of scale house)
970-482-1249
Hours: Mon.– Fri.
7 a.m.–5 p.m. (Apr.–Oct.)
7:30 a.m.– 4 p.m. (Nov.–Mar.)
Contact Information
For more information:
fcgov.com/rebates-programs
[email protected]
970-212-2900
V/TDD: 711
All parts must be removed
This facility may be closed
during periods of inclement weather
Tax Information
Residential water conservation rebates totaling $600 or more during
a program year may be considered as taxable income by the IRS.
Visit fcgov.com/residential-water-efficiency or contact your tax advisor
for additional details.
lose-a-watt.com
[email protected]
16-1581
Tenant
Street
City
StateZip
1 2
$30
$45
Wireless Rain Sensor
Soil Moisture Sensor
$50
$100
Purchase $100–$199
Purchase $200 or more
$40
$80
Purchase $80–$159*
Purchase $160 or more
Pre-approval
$50
Varies
Weather Station Add-On (for
existing controller)
PRV at Point of Connection
Precision Spray Nozzle
Precision Rotating Nozzle
High-Efficiency VAN
R-VAN Nozzle
Eco Stream Rotator
Rotary Nozzle
MP Rotator
Model
Pro PRS series
1800 PRS series
570Z-4 PRS
Hunter
Rain Bird
Toro
Drip Conversion Kit, Drip Line, Drip Emitters,
Pressure Reducer and Y-Screen, 1/4” Distribution Line,
Connection Fittings
50% rebate, not to exceed $50
DRIP CONVERSION KIT
Model
Manufacturer
QUALIFYING PRESSURE-REDUCING HEADS
Toro
Rain Bird
Orbit
K Rain
Hunter
Manufacturer
QUALIFYING HIGH-EFFICIENCY NOZZLES
Signature_____________________________________________________________ Date���������������������������������������������������
By signing this form, I certify that I purchased the fixtures or appliances as stated above and plan to install it (them) at the address indicated above within the Fort
Collins Utilities service area.
I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that state law requires me to provide proof that
I am lawfully present in the United States when asked as well as submission of a secure and verifiable document. I may also be required to provide proof of lawful
presence. I further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws
of Colorado as perjury in the second degree under Colorado Revised Statute 18-8-503 and it shall constitute a separate criminal offense each time a public benefit
is fraudulently received.
I, ________________________________________________________, swear or affirm under penalty of perjury under the laws of the State of Colorado that
(check one): I am a United States citizen. I am not a United States citizen but I am lawfully present in the United States pursuant to Federal law.
Affidavit – Restrictions on Public Benefits
Check here to sign up for a low-cost Home Efficiency Audit. Program rules apply. You will be contacted by phone to schedule an appointment.
Check here to receive a Tech Check— a free consultation to confirm your new sprinkler equipment has been installed and programmed correctly.
Check here to receive a free sprinkler audit. You will be contacted to schedule an appointment.
Check here to receive information about the Xeriscape Incentive Program.
WaterSense labeled
$100
WaterSense labeled
See list at right
See list at right
Eligible sensors must connect
to an automatic, in-ground
sprinkler system
REQUIREMENTS
Weather-Based Controller
Controllers and Add-Ons
$20
Purchase $40–$79
Pressure-Reducing Heads
$25
Purchase $50–$99
High Efficiency Nozzles
$15
REBATE
Wired Rain Sensor
Sensors
EQUIPMENT
Sprinkler Equipment Fort Collins Utilities water customers only. Not eligible for new construction.
WaterSense Labeled Showerhead – $10
Number of showerheads purchased:
Information on old toilets
Toilet #1: year ____________ or gallons/flush ______________
Toilet #2: year ____________ or gallons/flush ______________
ENERGY STAR® Clothes Washer – $50
Must be an ENERGY STAR 2015 qualified appliance
WaterSense Labeled Toilet – more than 1.0 gpf: $50; 1.0 gpf or less: $75
Number of toilets purchased: 1 2
Not eligible for new construction
See fcgov.com/toilet-rebates for qualifying models
ENERGY STAR Dishwasher – $25
Must be an ENERGY STAR 2012 qualified appliance
Fort Collins Utilities electric or water customers only
Eligible to Fort Collins Utilities water customers only
Appliances
Bathroom Fixtures
Daytime Phone _______________________________________ Email Address __________________________________________________
If different than installation
Mailing Address ___________________________________________________________________________________________________
Account # belongs to Landlord/Homeowner
Fort Collins Utilities Account # for Bill Credit ____ ____ ____ ____ ____ ____ - ____ ____ ____ ____ ____
Installation Address _________________________________________________________________________________________________
Customer Name ____________________________________________________________________________________________________
Qualified Fort Collins Utilities Residential Customers
2016 Conservation Rebate Application