OVER

2014 Summer Rain Barrel Program

Resident Information Sheet

Name (please print) __________________________________________________________

Address _______________________________________________________________

Phone______________________ E-mail____________________________________

Best Way to Contact You (circle one) Email Phone If by phone, when? _____________

CDC/Neighborhood _________________________________________________________

1) Do you have a standard 2x3
rectangular downspout on your home
or garage that is not visible from the
street? Yes No

If you have a 3 x4 or round downspout
you are currently not eligible to receive a
barrel as our diverters only fit on 2 x3
downspouts.



2) Does the downspout to which you
wish to attach the rain barrel drain to
the sewer (NOT over the driveway,
sidewalk or regular garden/bed)?
Yes No






3) Will you be able to install the downspout diverter prior to
delivery of the rain barrel? Yes No


Diverter is provided at no charge as part of the program and
available at your CDC office before summer. Residents
participating in the Summer Rain Barrel Program are responsible
for installing the downspout diverter that connects the downspout
to the rain barrel. The City of Cleveland and Youth
Opportunities Unlimited do NOT install diverters.
No
Yes No
Yes
No
Resident Installing Diverter

Please remember when printing this form to print double sided when possible.



4) Will it be a problem for someone to be present at the property
during barrel delivery and connection to the downspout diverter?
Yes No



For barrel delivery, you will receive a phone call at least two days prior
informing you of what day your barrel will be delivered. If you are
unable to be home when delivery occurs, then the barrel will be placed
in your backyard but not connected to the downspout diverter.


_____________________________________

In an effort to track the effectiveness of the Summer Rain Barrel Program, students will be
conducting surveys of barrel usage both in-person and over the phone during the summer
months starting in 2015.

5) Will it be a problem for a student worker to come on your property to survey your barrel in
future years to ensure you are using the barrel properly? Yes* No

For the survey work, you will receive a phone call at least two days prior informing you of what day
students will come to survey your barrel. *Answering yes may influence your eligibility to receive a barrel.


6) How did you hear about the Summer Rain Barrel Program? (circle all that apply)
Neighbor with a barrel Facebook/ Twitter CDC Newsletter/Publication Other________

7) Why are you interested in getting a rain barrel for your home?
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Property Owner Signature_________________________________ Date ________________
(Property Owner MUST sign form)

Please return completed form, along with the 2014 City of Cleveland Access Agreement and 2014 Youth
Opportunities Unlimited (Y.O.U.) Access Agreement, by July 1
st
2014 to your local Community Development
Corporation.





Resident Present with
Student Workers
2014 CITY OF CLEVELAND ACCESS AGREEMENT


THIS ACCESS AGREEMENT dated __________________, 2014, between the CITY OF
CLEVELAND (City), and the Owner of property located at ____________________________________,
(Address)
Cleveland, OH, __________ (Property) grants access to the City of Cleveland, Ohio, for the purpose
(Zip Code)
of implementing a rain barrel distribution program.

Owner requests City to access the Property to install a rain barrel on the premises and provide
guidance on use of the rain barrel. Owner grants permission for entry by City and its
agents/contractors, subject to the following conditions:

1. City agrees to connect rain barrel to downspout diverter if diverter is installed at time of rain
barrel delivery;

2. Owner or his/her agent agrees to be present during rain barrel delivery and downspout connection
for complete installation. If not present, Owner agrees to delivery of rain barrel without installation;

3. Owner agrees not to sell, dismantle or otherwise render the rain barrel or other related materials
unusable;

4. Owner agrees to cooperate with City in future access to property for the purpose of inventory and
stormwater assessment;

5. City agrees to cooperate with Owner to minimize any disruption of the Property; and

6. Acknowledging that City has an agreement with Youth Opportunities Unlimited Inc. (Consultant)
in which Consultant carries liability insurance, Owner agrees to indemnify and save harmless City
from any and all suits, claims, fines, loss, costs, damages, expenses and liabilities from Consultants
failure to comply with applicable laws or any negligent act of Consultant in performance of this
Agreement.

If owner fails to fulfill condition #3, the City may access the Property and remove the rain barrel.
The City shall provide the owner with proper notice, via mail before such access occurs.

The Citys Office of Sustainability is available to provide reasonable technical advice to owner on the
operation and maintenance of the rain barrel at the owners request. In fulfillment of this
commitment, the City may rely on the technical expertise of the Northeast Ohio Regional Sewer
District.

IN WITNESS HEREOF, the parties have executed this Access Agreement the day and year first
written above.

PROPERTY OWNER

Print Name: _____________________________________


Signature: _______________________________________ Date:_______________________

2014 YOUTH OPPORTUNITIES UNLIMITED ACCESS AGREEMENT


THIS ACCESS AGREEMENT dated __________________, 2014, between
YOUTH OPPORTUNITIES UNLIMITED (Y.O.U.), and the Owner of property
located at _______________________________, Cleveland, OH, __________ (Property)
(Address) (Zip Code)
grants access to Youth Opportunities Unlimited for the purpose of implementing a
rain barrel distribution program.

Owner requests Y.O.U. to access the Property to deliver a rain barrel to the
premises and provide guidance on use of the rain barrel. Owner grants permission
for entry by Y.O.U. and its agents/contractors, subject to the following conditions:

1. Y.O.U. agrees to assemble, deliver and assist the owner with the connection of
the rain barrel to the downspout diverter;

2. Owner agrees to be present during delivery of the equipment and connection of
the rain barrel to the downspout diverter. If not present, Owner agrees to delivery
of rain barrel without installation;

3. Owner agrees to be responsible for the installation of the downspout diverter;

4. Owner agrees to cooperate with Y.O.U. in future access to property for the
purpose of inventory and stormwater assessment;

5. Y.O.U. agrees to cooperate with Owner to minimize any disruption of the
Property; and

6. Owner agrees to indemnify and save harmless Y.O.U. from any and all suits,
claims, fines, loss, costs, damages, expenses and liabilities in performance of
this Agreement.


IN WITNESS HEREOF, the parties have executed this Access Agreement the day
and year first written above.


PROPERTY OWNER

Print Name: _______________________________


Signature: _________________________________ Date:_______________________