Request a Billing Adjustment for Loss of Water / Leak

About This Form

NOTE: This form is ONLY for requesting a billing adjustment for leaks or water loss. To report other kinds of leaks:

Report a Street Leak form: Report a water leak in the street or public right-of-way. For water emergencies (i.e., a potential main break), please call 415.945.1500.
Report Water Waste form: Report water being wasted on a property, such as excess irrigation water running off the property, broken or misdirected sprinklers watering pavement or watering in the middle of the day.

Guidelines

Marin Water’s Leak Adjustment program is for customers who experienced a water loss/leak, have fully repaired and addressed the water loss/leak and have not received an adjustment in the previous 36 months. A second water loss would be eligible to substitute for the first adjustment, provided the customer meets the requirements. The requirements and details on the program and information on how the adjustment amount is calculated are located in Marin Water’s Code Section 6.01.090 (Adjustment of Bills for Loss of Water).

Program Requirements

The water service must be in your name or you must be an authorized representative named on the water account.
Submit proof of corrective action to stop the water loss within 48 hours of discovery or notification of high consumption, pursuant to Marin Water’s Code Section 13.02.020(1)(b).
1. Notification of high consumption examples include but are not limited to, bill reflecting increased consumption, door hanger, phone call, leak alert, email.
Submit proof of leak repair.
Submit proof of denied claim with your insurance company for adjustments in excess of $5,000.
Submit signed completed application, with all required documentation within thirty days from the billing date for the period in which the water loss occurred. Incomplete applications will be denied and require re-application.

Please note: Marin Water reserves the right to request additional information at any time. Marin Water may modify any or all eligibility criteria or program components, including discontinuing the program, by action of the Board of Directors.

Submit this online request form, along with proof of repair, within thirty days from the billing date for the period in which the water loss occurred. Alternatively, you may mail the completed form and proof of repair to: Leak Adjustment Marin Municipal Water District, P.O. Box 994, Corte Madera, CA 94976-0994. If submitting by mail, download the pdf version of the form.

Please contact Customer Service at 415-945-1400 for additional information.

Request a Billing Adjustment for Loss of Water

Complete ALL steps below. Incomplete applications will be denied and require re-application.

"*" indicates required fields

Customer Information

Customer Name*

Customer Number*

Service Number*

Phone Number*

Email*

Service Address

Address*

Street Address City State ZIP Code

Water Loss Details

Location of water leak*

Water loss occurred*

Corrective action to stop the water loss occurred*

FINAL repair to address all leaks at the service address occurred*

Describe the circumstances of the water loss, including the corrective action taken to stop and repair the water loss within forty-eight hours of discovering or being notified of a leak.*

Required Documentation

Upload all required documentation (refer to program requirements)*

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 15 MB, Max. files: 10.

Declaration

Name of Applicant*

Electronic Signature*

By typing my name above, I certify under penalty of perjury that the information on this application is truthful and correct. I have read and understand the requirements of the Leak Adjustment Program and certify that I meet all of the program requirements. I understand that if I receive an adjustment without qualifying for it, I may be required to pay back the adjustment I received.

Yes

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