545 Corinth Road, Newnan GA (770) / (770) fax

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1 Deposit Amount $ Please complete the form below to apply for service: Information needed below: 1) PROOF OF OCCUPANCY: A signed Lease or Purchase Agreement that includes the applicant s name and address 2) IDENTIFICATION: Copy of a government-issued photo ID Coweta County Water & Sewerage Authority requires a credit check on all new customers Customer Name Social Security Number Date of Birth Service Address City State Zip Code Billing Address If Different from Service Address City State Zip Code Employer Work Phone Daytime Phone Cell/Other Phone Address Service To Connect Water Sewer Date Service Desired Have you ever had water or sewer service in your name with Coweta County Water & Sewerage Authority in the past? I have read or been explained the terms and conditions and understand my responsibilities incurred by my request for water or water/sewer service. The rate structure for water or water/sewer has been explained to me and I understand it. I understand that I will be responsible for any and all costs associated with the recovery from any delinquent accounts, including but not limited to reasonable attorney s fees and costs for collection or with a collection agency. Signature Date 545 Corinth Road, Newnan GA (770) / (770) fax

2 Leak Adjustment Policy Coweta County Water & Sewerage Authority is committed to water conservation and encourages customers to do their part to reduce lost water by repairing leaks in a timely manner. In addition, there are significant costs in producing clean water and delivering it on a continuous basis to your home or business. Coweta County Water & Sewerage Authority is responsible for providing water to its customers at each meter location and customers are responsible for properly maintaining their water system and any irrigation system connected to their side of the meter. The customer (account holder) is responsible for any water lost due to leaks or breakage of their lines. Coweta County Water & Sewerage Authority may grant a leak adjustment, at its sole discretion, subject to the following qualifications: Following notification by the Authority or detection by the customer, leaks must be repaired within 10 calendar days or any adjustment, granted at the Authority s sole discretion, will be forfeited. The leak causing the high consumption must be repaired and Authority technicians will confirm the repair. No leak adjustment will be given for any reason other than a leak. As an example, filling a pool, leaving a hose or faucet on or overuse of irrigation systems does not constitute a leak under terms of this policy. Customer must make a written request for a leak credit by fully completing the Leak Adjustment Request form (located at Documents & Applications Leak Adjustment Request). Proof that the leak has been repaired must be provided in the form of a receipt for supplies purchased (if repaired by the customer) or from a licensed plumber. No leak credit will be issued without the submission of all appropriate documentation. A prior leak adjustment must not have been granted during the past twelve (12) months. Customer s account at Coweta County Water & Sewerage Authority must be paid in full and in good standing. Customer must pay at least the usual monthly payment while the leak adjustment is considered by the Authority. Abuse of this policy is strictly prohibited. Any customer abusing this policy will have their leak adjustment reduced and/or denied. The CEO of the Authority retains final discretion on all leak adjustments. Leak Adjustment Policy (v.2) Page 1 of 1

3 Effective October 1, 2015, Coweta County Water & Sewerage Authority is implementing a Leak Insurance Program to accompany its updated Leak Adjustment Policy, which is enclosed. This past year, the Authority adjusted bills for hundreds of customer-side leaks; however, even after adjustment most customers were financially impacted when paying the remaining balance. We have developed a leak insurance program to assist our eligible customers as homeowners insurance does not cover the cost incurred for water. Details of the Leak Insurance Program are below along with coverage amounts charged per meter: Eligible residential and irrigation customers are enrolled in the first tier of residential and irrigation insurance coverage, which is $1,000 coverage (per year) for $2.00/month. Additionally, you may request to enroll in the second tier, which is $2,000 in residential and irrigation coverage (per year) for $4.00/month. Eligible Commercial, Industrial and School (CIS) customers are enrolled in the first tier of CIS insurance coverage, which is $5,000 coverage (per year) for $10.00/month. Additionally, CIS customers may request to enroll in the second tier, which is $10,000 of CIS coverage (per year) for $20.00/month. With Coweta County Water & Sewerage Authority s Leak Insurance Program, should you have a leak you are not responsible for paying water charges up to the covered amount for one leak every 12 months. For water charges in excess of coverage, we will apply an adjustment following application of insurance. Please read on for details of a recent customer-side leak and how this program would have affected the customer s out-of-pocket expense Following a leak at his home, our customer was distressed to receive a bill totaling $2, We adjusted the bill for $1, leaving a balance owed of $1, If this customer had selected the $2,000 residential and irrigation leak adjustment insurance, for $4.00/month (or $48.00/year) he would have only paid $ following adjustment rather than over $1,300! If the customer had selected the $1,000 residential and irrigation leak adjustment insurance, for $2.00/month (or $24.00/year) he would have paid $ following adjustment rather than over $1,300! Beginning with your monthly water bills due from October 1, 2015 forward, we will apply an insurance charge of $2.00/month for $1,000 leak adjustment insurance for residential and irrigation and $10.00/month for $5,000 leak adjustment insurance for CIS service. If you wish to apply for the higher tiers of coverage, please us at contactus@cowetawater.com or call (770) Should you decide to not participate in our Leak Adjustment Insurance program, please let us know that you wish to opt out by ing us at contactus@cowetawater.com, or completing the waiver contained within this document. We will remove the charge on future bills; however, please note that you will be responsible for paying all balances due after we provide any adjustment subject to our updated Leak Adjustment Policy and at our sole discretion. Leak Insurance Program Page 1 of 2

4 No credit will be given in any twelve (12) month period above the insurance coverage amount for one leak occurrence; nor to anyone who has opted out of coverage. Leak Insurance Program as implemented by the Coweta County Water & Sewerage Authority, shall mean a program by which eligible customers will be protected from inordinate charges in the event of a leak as defined in the updated Leak Adjustment. No protection is afforded to any eligible customer who fails to repair a defective waterline leak after ten (10) days of notification or detection of said leak. The Authority may deny leak protection coverage partially, or in its entirety, at its sole discretion Notice to Opt Out of Coverage Customer Name: (Print) Account Number: Service Address: (Print) Contact Phone Number: By my signature below I hereby opt out refusing the Leak Insurance Program and request the monthly leak insurance charge removed from my monthly bill. I understand that I am responsible for paying all balances due after the Authority provides any adjustment subject to the updated Leak Adjustment Policy and at its sole discretion. Signature: Date: Leak Insurance Program Page 2 of 2

5 Terms & Conditions Residential Accounts To our Valued Customer: These terms and conditions are provided for your benefit to communicate Coweta County Water & Sewerage s policies regarding our billing procedures, payment terms, and fees. By requesting our services, you agree to all of the conditions listed in this document. New Service: A $25.00 Service Activation Fee will be required at the time of new service or will be charged on the first billing statement. A credit check is required on all new customers. Deposit: Coweta County Water & Sewerage Authority requires a deposit depending on credit history and you must provide a valid Social Security number. Deposit Range: $0.00 to $ Please note: Commercial accounts are required to pay a deposit. When service is terminated, the deposit on the account will be applied toward any outstanding balance. If there is no balance due, a refund check will be mailed to the forwarding address at the regular bill cycle. - Proof of Residency: Lease or Hud Statement that includes the applicant s name and address. - Personal Information: Name, mailing address, Social Security number, phone number and valid identification. Billing Cycle: Coweta County Water & Sewerage Authority bills on a monthly basis. The billing date is determined by your location within our service area. Due dates are not adjustable. Payment Terms: Payments are due within 15 days of the bill date. Failure to receive bill does not exempt penalties or disconnection for non- payment. We are not responsible for late remittances made through the mail service. Billing disputes must be made within 30 days of bill date. Disconnect Penalty: Any past due balance not paid within 10 days after the due date will be charged a $50.00 continuation service fee and service disconnected. Service will be reconnected after past due bill and service fee is paid in full. Late Fee Penalty: If bill is not paid by 5:00 p.m. on the due date, a 10% late fee will be added to your bill. You will not receive any reminder notices for past due accounts. Only one bill per month. Returned Payments: Returned payments will be charged a $30.00 fee and service disconnected. No notice will be sent before disconnection due to your bank notification. After three returned payments on the account, we will no longer accept checks, only cash, money order, or debit/credit card. Signature Date Terminate Service: The person that is listed on the account must call to terminate the service when needed. The service will be disconnected the next working day or a specific date requested except Saturday or Sunday. A final reading will be taken on requested date and a final bill or check will be mailed to forwarding address given. Any outstanding balance not paid within 60 days of due date will be turned over to collections. Reinstated Service: Any account with outstanding balance or bad debt on file with Coweta Water & Sewerage Authority will be required to pay entire balance before new service can be established. Along with any deposits required. Tampering Policy: If a meter or service equipment has been tampered with for the purpose of defrauding the Authority, the service will be disconnected immediately. A Tampering Fee of $100 to $300 will be due before service can be restored. Additional Fees/Service Fees: Recheck Meter Reading or Leak $25.00 Customer Cut Pad Lock Fee $75.00 Customer Cut Water Back on $50.00 Cut-On Due to Return Check $25.00 Same Day service after 2:00 pm $25.00 Cut on/off Irrigation Meter $50.00 Work Order Trip Fee $25.00 Manual Phone Payment (with CSR) $ 5.00 Credit / Debit Card unauthorized use $50.00 Water Leaks Policy: If a water leak is found and it is on the customer s side of the meter, it is the customer s responsibility to have the water leak repaired immediately and to pay for all water charges. If a water leak is found by an Authority service technician, the Authority has the right to cut the water off until the customer can have the leak repaired. Water should be turned off when not in use until the customer can have it repaired. Payment Options: Online at Bank Draft Phone payment with credit card with automated phone system Mail to address listed on monthly bill Night Drop Make payment at our office/sub-office during regular business hours For more information on Backflow, Irrigation, or Rates fees see our website: Terms & Conditions Subject to Change Main Office 545 Corinth Rd Newnan, Ga Regular Business Hours Monday-Friday 8 am-5 pm Payment Center Coweta Fayette EMC 14 Hospital Rd Newnan, Ga (Behind Hardees) 545 Corinth Road, Newnan GA (770) / (770) fax