Landscaping and Irrigation Evaluation Program

Landscape and Irrigation Evaluation Program
FL#
During the landscape and irrigation evaluation, the contractor will assess the property and make recommendations to conserve water. This includes checking the irrigation timer for proper programing and run times, checking the irrigation system for leaks, broken heads, coverage, water use per cycle, and review plant placement and irrigation zones.
Program Qualifications:

Active customer of a participating utility within Polk County (go to SavePolkWater.org or call your utility)Home has an operating automatic irrigation systemLocation must have at least 12 months of history, of which the last 3 must average at least 14,000 gallons per monthAgree to installation of a FREE rain sensor if the irrigation system lacks an operational automatic shut-off in accordance with Florida Statute 373.62Agree to participate in a free follow-up evaluation regarding the suggested modifications in the future
Steps to Apply
1. Complete this form
2. Submit it to your utility using the button below or provided on the PRWC website.
3. Utility will verify eligibility and contact you and our contractor.
4. The Contractor will contact you or your designee to set up a meeting time.
5. A responsible adult must be on-site for the landscape evaluation, and to provide access to your time clock to check your irrigation system.
6. Complete satisfaction survey after evaluation.
Please note: Irrigation system evaluators will evaluate the system and plantings but are not authorized to make modifications other than the time clock and rain sensor installations. Any costs incurred in making recommended modifications will be at the participant’s expense.
Applicant Information:
Utility*
Billing Account #
Last Name*
First Name*
M.I.
Street Address*
Unit #
City*
Zip Code*
Relationship to property*
U.S. Phone
Email*
example@example.com
Mailing Address (if different from above)
Building/Property Information: Please select*

Single Family (With HOA)Single Family (Without HOA)Multi-Family/ApartmentCommercialHOA Common AreaOther
If Multi-Family/Apartment is selected, how many Units?
Subdivision
Gate Access Code (if applicable)
Number of time clocks*
Number of zones*
Size of property*
Percentage lawn
Agreement of Terms and Conditions
By submitting this application, I agree that I have read and will abide by the program guidelines as outlined herein. In addition, I certify that my entire irrigation system is in good operating condition. In the event my irrigation system is inoperable at the time of the scheduled evaluation, I understand that I may be charged by the contractor for their time and mileage costs, and that I will be ineligible to receive the requested evaluation or rain sensor. I further understand that my water consumption information will be included in the final report for this project to the Southwest Florida Water Management District. The customer agrees that in order to participate in this program, the County's contractor shall have the right to enter the property of the water customer, after contact with the customer or representative, for the purpose of performing duties related to this Landscape and Irrigation Evaluation Program. By signing and submitting this form, I affirm that I am the legal property owner, water account holder, or contracted property manager for this address, or am otherwise authorized to sign and submit for the property owner. The Utility may deny any application that does not meet program requirements. The undersigned expressly agrees to hold harmless the Utility, contractor, and/or Polk Regional Water Cooperative 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 the Landscape and Irrigation Evaluation Program. The Utility reserves the right to alter this program at any time. Program funding is limited to available resources. For further questions, please contact your Utility.

I have read, understand, and agree to the terms and conditions of this program.
Signature of Applicant*

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Date*

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Date
For Official Use Only
Reservation #
Application

ApprovedDenied
Reviewed by
Reason for Denial
Date of Follow-up Inspection

MonthDayYear
Date
Follow-up Inspection

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Total cost
Utility cost
District cost
Date to Accounting

MonthDayYear
Date
Check #
Payment Date

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Date
Should be Empty:

Landscape and Irrigation Evaluation Program

Applicant Information:

Agreement of Terms and Conditions

For Official Use Only