Utility Application Utility Application City of Sergeant Bluff Application for Utility Service This application must be completed in order to initiate service with the City of Sergeant Bluff. A deposit is required to begin service, please contact City Hall for instructions on how to make that payment. Please review the information and instructions regarding the utility bill due date, garbage carts, rights and responsibilities, late fees, penalies and other charges below the signature line of this form. You must then scroll down and hit SUBMIT.Name of Applicant* First Last Name of Co-ApplicantUse this section only if there will be a secondary person responsible for the account. They will be required to sign this application. First Last Date That Service Is To Begin* MM slash DD slash YYYY Service Address* Street Address Mailing AddressComplete this section only if your mailing address will be different than the service address. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Applicant's Date of Birth MM slash DD slash YYYY Applicant's Social Security Number Applicant's Employer Primary Applicant Phone#Email of Applicant Co-Applicant's Social Security Number Co-Applicant's Date of Birth (if applicable) MM slash DD slash YYYY Co-applicant Phone # (if applicable)Co-Applicant's Employer (if applicable) Attach a copy of your ID or Drivers LicenseA copy of your ID (and co-applicant's ID) is required to complete your application. You may take a picture on your phone and attach it or you can e-mail it to CityHall@cityofsergeantbluff.com. Drop files here or Select files Max. file size: 256 MB. Emergency Contact Name & Phone Number Are you renting this property?* Yes No If Rental - Who is the Landlord/Owner?If Rental - Provide the lease agreementA copy of your lease agreement is required to complete the utility application. You may also e-mail it to CityHall@cityofsergeantbluff.com Drop files here or Select files Max. file size: 256 MB. Deposit Required*I understand utility services will not be transferred into my name until I have contacted City Hall to pay the utility deposit. (712) 943-4244 Yes Signature of Applicant - I hereby apply for utility services, for the premises listed above, pursuant to the rules and regulations of the City of Sergeant Bluff. I agree to pay all bills rendered by the City of Sergeant Bluff until I give written notice to the City of Sergeant Bluff to discontinue said utility services. The above referenced deposit is intended to guarantee payment of bills as required for each service connection. An additional deposit may be subsequently required if the deposit is found to be insufficient and the account becomes marked by untimely payments. I understand that this deposit will be applied to my account upon termination of services. If the deposit is less than my final bill, I will promptly pay the balance due. If the deposit is more than my final bill, the City of Sergeant Bluff will refund the credit balance. Additionally, I understand that the deposit will be refunded as a credit to my account only after 12 consecutive months of prompt payment (payment made on or prior to the due date). By signing below I acknowledge all information above to be true and correct.* Signature of Co-Applicant (if applicable)DEPOSIT INFORMATION A deposit shall be refunded after twelve consecutive months of prompt payment (which may be eleven timely payments and one automatic forgiveness of late payment). For refund purposes, the account shall be reviewed for prompt payment after twelve months of service following the making of the deposit and for each twelve-month interval terminating on the anniversary of the deposit. Upon termination of service, the deposit, less any unpaid utility bill of the customer, shall be reimbursed to the customer or other person who made the deposit.DUE DATE INFORMATION Utility bills are mailed out monthly, the first of every month. Payment is due by the 20th of each month unless the 20th falls on a Saturday, in which case, payment is due on Friday. If the 20th falls on a Sunday, the payment is due the next business day following the 20th. WE ARE NOT RESPONSIBLE FOR THE U.S. MAIL DELIVERY. FAILURE TO RECEIVE BILL DOES NOT EXCUSE PAYMENT.GARBAGE CART INFORMATION THE CITY WILL E-MAIL YOU THE GARBAGE CART #'S ASSOCIATED WITH YOUR PROPERTY. EACH CART HAS A SPECIAL SERIAL NUMBER. YOU HAVE 10 BUSINESS DAYS FROM TO VERIFY THE ACCURACY OF THE NUMBERS PROVIDED BY E-MAIL. ONCE VERIFIED FOR ACCURACY, THE CART(S) BECOMES YOUR RESPONSIBILITY. THERE IS A $100 REPLACEMENT COST FOR EACH LOST CART. THE CARTS ARE THE PROPERTY OF WESTERN DISPOSAL. IN THE EVENT THE RESIDENTIAL CUSTOMER REQUESTS ADDITIONAL GARBAGE CARTS, THE CITY SHALL CHARGE THE CUSTOMER FOR A MINIMUM OF TWELVE (12) MONTHS FOR EACH ADDITIONAL CART. IF THE RESIDENTIAL GARBAGE CUSTOMER FAILS TO MEET THE MINIMUM LENGTH OF USE THE CONTRACTOR MAY COLLECT $75 FOR EACH ADDITIONAL CART. YOU HAVE 10 BUSINESS DAYS TO DECIDE WHETHER YOU WOULD LIKE TO KEEP ANY ADDITIONAL CARTS THAT WERE ON THE ACCOUNT PRIOR TO TAKING OWNERSHIP.CUSTOMER RIGHTS & RESPONSIBILITES TO AVOID SHUTOFF OF ELECTRIC SERVICE FOR NONPAYMENT What can I do if I receive a notice from the utility that my service will be shut off because I have a past due bill? Pay the bill in full; or Enter in to a reasonable payment plan with the City of Sergeant Bluff; or Apply for and become eligible for low‐income energy assistance by contacting the Community Action Agency at 274‐1610; or Give the utility a written statement from a doctor or health care official stating that shutting off electric service would pose an especial health danger for a person living at the residence; or Tell the utility if you think that part of the amount shown on the bill is wrong. However, you must still pay the part of the bill that you agree you owe. When can the utility shut off my utility service because I have not paid my bill? The utility can shut off service between the hours of 8 a.m. and 2 p.m., Monday through Friday. The utility will not shut off your service on nights, weekends, or holidays for nonpayment of a bill. The utility will not shut off your service if you enter into a reasonable payment plan to pay the overdue amount. The utility will not shut off your service if the temperature is forecasted to be 20-degree Fahrenheit or colder during the following 24 hour period, including the day your service is scheduled to be shut off. If you have qualified for low‐income energy assistance, the utility cannot shut off your electric service from November 1 through April 1. However, you will still owe the utility for the service used during this time. The utility will not shut off your service if you have notified the utility that you dispute a portion of your bill and you pay the part of the bill you agree is correct. LATE FEES, PENALTIES, AND DISCONNECTION FEES Utility rates are available on the City’s website, www.cityofsergeantbluff.com The following fees are subject to change: Returned Check Fee: $30.00 If two or more checks are dishonored within a six-month period, the utility shall require future payments to be by cash, cashier’s check, postal money order or electronic transfer. Late payment penalty: $5 for water service $5 for sewer service 1 ½ % all other services Red Tag Fee (for processing of disconnection notices): $30.00 Charge to process paperwork to reconnect electric service following Monday – Friday Only Disconnection due to nonpayment: Before 4 p.m.: $60.00 After 4 p.m.: $150.00 Charge to process paperwork to reconnect water service following Monday – Friday Only Disconnection due to nonpayment: Before 4 p.m.: $30.00 After 4 p.m.: $55.00 Upon termination of services you will have 30 days to pay final bill. If payment is not received in full upon the end of the 30 days, you will receive notification that within 10 days your account will be turned over to the State of Iowa’s Offset Program AND Noll Collection Service.
