Fillable Printable Customer Order Form - Department of Public Works

Customer Order Form - Department of Public Works

COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS

WATERWORKS DIVISION

CUSTOMER ORDER FORM

www.lacwaterworks.org

1-877-637-3661

900 S. Fremont Avenue 260 East Avenue K8 23533 Civic Center Way

Alhambra, CA 91803 Lancaster, CA 93535 Malibu, CA 90265

(626) 300-3335

(626) 300-3385 FAX (661) 723-7027 FAX (310) 317-4674 FAX

NOTE: Where there has been a change in property ownership or tenancy, thereafter, the water service is temporary and subject to shut off without further notice pending satisfaction of

Waterworks Division requirements. The water service can only become permanent upon satisfaction of Waterworks Division requirements, including payment of outstanding bills,

completion and signing of this form, and presentation of verifiable proof of ownership.

SERVICE ADDRESS: ____________________________________________________CITY:__________________________________ACCOUNT NO._____________________

DO YOU HAVE (OR EVER HAD) A WATERWORKS DISTRICT ACCOUNT: ____YES ____NO IF SO, ADDRESS ____________________________________________

This is a "Customer Order Form for the County of Los Angeles Department of Public Works Waterworks Division" which is to be completed and signed by the owner of the property (and

the payer under certain conditions). The purpose of this form is to provide the Waterworks Division with correct billing information and to notify the property owner that he/she is

ultimately responsible for the water bill for the property in accordance with Rules 1-H-22, 1-H-25d, and 1-H-26d of the Rules and Regulations of the County of Los Angeles Department

of Public Works Waterworks Division as given on the reverse. The Customer Order Form must be completed, signed, and received by Waterworks Division, including an acceptable

document verifying proof of ownership, before permanent water service can be provided. Owner identification with signature is also required. In the event a properly signed form is not

on file with the Waterworks Division, the water service will be subject to discontinuance without further notice. The owner may request that the bill be sent to someone else, such as the

tenant designated as the payer. If this is the case, the payer is also to sign the form before it is returned to Waterworks Division. However, the owner shall be responsible for the bill

at all times.

NOTE: Tampering with Waterworks Division equipment may result in meter removal and the requirement that repair charges be paid before service will be restored

I (WE) THE OWNER (S) OF THE PROPERTY AT THE GIVEN ADDRESS AGREE TO ACCEPT RESPONSIBILITY FOR PAYMENT

OF THE WATER BILLS FOR THIS LOCATION EVEN IF THE DESIGNATED PAYER DOES NOT PAY THE BILL.

PRIMARY OWNER (PLEASE PRINT) DRIVERS LICENSE NO. STATE SIGNATURE

SECONDARY OWNER DRIVERS LICENSE NO. STATE SIGNATURE

MAILING ADDRESS CITY STATE ZIP CODE

PRIMARY TELEPHONE NO. CELL NO. BUSINESS NO. PURCHASE DATE DATE SIGNED

EMAIL ADDRESS:

Enclose either a copy of the recorded Grant Deed or another equivalent document acceptable to Waterworks Division verifying the Owner's interest in the property. If a Deed or

other document is not available due to recent purchase, a letter from the Escrow Company stating that the Deed has been recorded transferring interest and giving recording date

and names of prior and new owners will be accepted on a temporary service basis for up to sixty (60) days pending receipt of the copy of the recorded Deed.

I, (WE) THE TENANT/PAYER AM (ARE) AWARE THAT THE OWNER HAS DESIGNATED ME (US) TO RECEIVE AND TO PAY

THE WATER BILL FOR THIS LOCATION.

TENANT/PAYER NAME (PLEASE PRINT) DRIVERS LICENSE NO. STATE SIGNATURE

SECONDARY TENANT DRIVERS LICENSE NO. STATE SIGNATURE

MAILING ADDRESS CITY STATE ZIP CODE

PRIMARY TELEPHONE NO. CELL NO. BUSINESS NO. DATE SIGNED MOVE IN DATE

EMAIL ADDRESS:

FOR OFFICE USE ONLY: DATE RECEIVED: ________________________________ EMPLOYEE INITIALS: ____________________

MOVE IN/OUT ENTERED: ______________________ PICK UP / ACTIVE ______________________________

RULE 1-H-22

CUSTOMER ORDER FORM: No charge will be made for the mere turning on of the water supply upon the opening of a new account for any kind of

service. An application form provided by the District must be signed by the applicant. Such application will be known as "CUSTOMER ORDER FORM"

and shall contain the following provisions.

Applicant shall agree to accept the services applied for subject to the rules and regulations of the District and to pay theretofore at regular rates.

Should the applicant subsequently cancel one or more items of services, such cancellation shall not change or affect the items of his application in

respect to the remaining item or items of service.

When a customer/applicant has requested water service to be initiated (turned on) or discontinued (turned off), the District requires at least one (1)

working day (24 hours) advance notice. The provisions of the application, obligating the applicant to accept and pay for service shall remain in force

until said notice is given and the customer is obligated to pay all bills in full to date of receipt of said notice by the District.

Applicant shall further agree to assume all liability for any damage occurring on the premises served, or elsewhere, by reason of open faucets, faulty

fixtures, or broken pipes at or after the time when service is turned on, whether or not at the time of turn on there was a responsible person on the

premises.

Whenever there is a change in customer status through change in ownership or tenancy of a premise, there shall be filed with the District a Customer

Order Form signed by the owner and by the tenant where applicable. For Marina Del Rey Water Systems, the lessees are considered to be "owners"

for the purpose of this sub-rule.

The Customer Order Form will be furnished by the District to the new customer or the customer's agent or representative for the customer, if not the owner, to

obtain the owner's signature. Should the new customer not be the owner of the premises and the owner's signature cannot be obtained prior to the new customer

occupying the premises and requiring water service, the District will accept a Temporary Customer Order Form signed by a person who is an authorized agent, or

representative of the owner. The Temporary Customer Order Form must be replaced by a Customer Order Form signed by the owner within thirty (30) days

following the commencement of service. Should there not be a valid Customer Order Form on file with the District, water service to the premises may be subject to

discontinuance at the option of the District.

Service may be denied a new applicant if he fails or refuses to provide necessary billing information such as the name of the previous owner, realtor, or

broker handling the transaction, or some responsible party who has managed or will manage the property.

Should the owner of the premises re-designate by Customer Order Form at any time that the water bill is to be delivered to any other address; the

District will endeavor to do so as of the next bill.

The Customer Order Form when filed with the District is to be accompanied by a document verifying proof of ownership of the premises by the owner who signed

the Form. Should such document not be readily available, the District will accept temporarily in lieu of a letter from a bank or escrow service company stating that the

name of the owner and the date ownership began. The property ownership document must then be filed with the District within sixty (60) days, or the water service

will be subject to discontinuance thereafter without further notice. Proof of ownership documents shall be in the form of acceptable title documents.

Should the District not receive the Customer Order Form and the ownership verification document within the time period allowed, the District may

initiate service termination proceedings similar to that given in Rule l-H-26g including requiring payment of the reconnection and restoration charge.

RULE 1-H-25d

Unless the applicant for water service specifies otherwise to the District, all bills will be mailed to the same address to which water service is furnished.

The District may at its option and upon written request of the owner (where the bill is designated to be sent to a tenant or agent at an address different

than the owner's address) may send to the owner a duplicate copy of any bills of the premises.

Upon written request by the applicant or customer the District will render up to a triplicate billing for an account on a regular basis until notified to do otherwise.

RULE 1-H-26d

Water bills may be addressed in the name of the property owner or other person in possession of the property served, or the applicant for water service. The addressee

of the water bill shall be primarily responsible for payment thereof, but the District reserves the right to hold the property owner ultimately liable for water service furnished

to the premises subsequent to the date of purchase by the owner.

All water bills sent to a tenant, a lessee, a person buying property on term contract (option to buy) shall remain ultimately the owner's responsibility.

Should property under contract go into foreclosure, or should said contract be returned to the owner, such water bills shall ultimately remain the owner's

responsibility.

"Date of purchase' shall be defined as being the date of document transferring title to parcel of property from the prior owner to a new owner. Date of closure of

escrow for transferring title to a premise may be accepted by the District in lieu of the "Date of Purchase." Changes in name and reorganization of companies owning

property shall be not considered as being a change in ownership.

All water bills incurred by a premise prior to a date of purchase shall be the responsibility of the owner of the premises subsequent to the date or purchase.

CHANGES TO THIS FORM MUST BE REVIEWED AND APPROVED BY COUNTY COUNSEL