CITY OF RICHMOND DEPARTMENT OF PUBLIC UTILITIES
Lead Service Line (“LSL”) Replacement Grant Program Application
Section 1 – Address of Eligible Property (the “Property) (must be in City limits)
Street Address Tax Parcel ID
City Zip Code
Section 2 – Property Owner (the “Owner”) Information
First Name Last Name
Daytime Phone
Email
Mailing Address (if different from above)
City State Zip Code
Section 3 – Plumber Lead Verification and Itemized Cost Estimate for LSL Replacement
I am an LSL Program certified plumber and/or work for an LSL Program certified plumber.
I verified there are lead service lines at the Property and provided the Owner photographic evidence of
LSLs on the Property to submit with this application.
I provided the Owner an itemized cost estimate for the LSL replacement at the Property to submit with
this application.
Plumber Name Plumber Signature
Plumbing Company Name Plumber Phone Number
Section 4 – Grant Disbursement Conditions
The City reserves the right to deny any application, and submitting an application does not guarantee an
award of monies. Grant disbursement monies are subject to the availability of allotted grant funds. The
City reserves the right to determine eligibility of the Property.
There must be an existing, occupied home, or home under active renovation, with a lead service line on the
Property.
Disbursement amounts will be paid directly to contracted plumber for direct costs not to exceed
$2,500 for lead service line replacement. The Owner is responsible for any amount above the
disbursement amount.
Property address must not be in arrears on any amount owed to the City.
Owner and plumber must execute agreement provided by the City after acknowledgment of this application.
The lead service line replacement must be performed by a plumber on the List of Grant Program Certified
Plumbers.
Section 5 – Acceptance of Conditions
In applying for participation in the Grant Program, I understand and agree to the following:
I will own and be solely responsible for the maintenance of any replaced lead service line on the Property.
I hold the City harmless from any liability related to the work performed on the Property related to the
lead service line replacement.
I understand the City does not guarantee the work done by my contracted plumber.
I waive and release any claim or action against the City for losses, damages, expenses or costs resulting
from or related to my application to or participation in the Grant Program and indemnify the City against
any such claim or action made or taken by someone else.
I understand that if any materially false information, statement or representation is found in this
application or supplemental documents, the City reserves the right to:
o reject my application,
o demand from me full and immediate repayment of any Grant money paid to my plumber for work
performed on the Property, and
o take legal action against me.
Property Owner Signature Date
Application Submission/Contact Information
Mail, deliver, or email the completed application and a photo showing lead service lines on the Property to:
Lead Service Line Replacement Grant Program
City of Richmond Department of Public Utilities
Development Services
900 E. Broad Street, Room 115
Richmond, VA 23219
DPU.DevelopmentServices@Richmondgov.com
Questions can be directed to DPU Development Services (804-646-8544).
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