HomeMy WebLinkAboutMinutes - May 4, 2004 SSCITY OF LODI
INFORMAL INFORMATIONAL MEETING
"SHIRTSLEEVE" SESSION
CARNEGIE FORUM, 305 WEST PINE STREET
TUESDAY, MAY 4, 2004
An Informal Informational Meeting ("Shirtsleeve" Session) of the Lodi City Council was held Tuesday,
May 4, 2004, commencing at 7:00 a.m.
A. ROLL CALL
Present: Council Members — Beckman, Hitchcock, Howard, Land, and Mayor Hansen
Absent: Council Members — None
Also Present: City Manager Flynn, Interim City Attorney Schwabauer, and Deputy City Clerk Taylor
B. CITY COUNCIL CALENDAR UPDATE
Deputy City Clerk Taylor reviewed the weekly calendar (filed).
C. TOPIC(S)
C-1 "Lodi Care Package Program"
City Manager Flynn reported that while current programs are in place, staff is addressing
the Council to obtain guidance toward formalizing and standardizing programs to provide
financial assistance to customers who are on fixed incomes and/or have hardships which
make it difficult for them to pay for City services.
Electric Utility Director Vallow stated that the inevitable cost of providing services and the
recent energy crisis have caused a large segment of the population to be impacted by rate
increases. Some customers are annoyed by this, and some customers simply cannot
afford to pay for services. While Lodi Electric Utility is mandated and obligated to offer
assistance to customers that are below existing Federal Income Guidelines (FIG), other
utility assistance programs such as water, wastewater, and refuse are not as clearly
defined.
Rob Lechner, Customer Services and Programs Manager, reviewed his overhead
presentation regarding a proposed program offering combined assistance entitled, "Lodi
CARE" (filed). A partnership has been created by the City of Lodi Electric Utility, Public
Works, and Finance Departments, along with Central Valley Waste Services and the Lodi
Salvation Army. The program would offer assistance to low-income customers, paying their
combined electric, water, wastewater, refuse bill (cap at $125) once within a six-month
period, a maximum of two times in 12 months (cap at $250 per family per year). The
$105,000 budget estimate allows for the program to assist 336 families twice annually, or
672 families if each received one grant annually. Mr. Lechner related that customer/client
relief information was formulated at $125 maximum based on analyzing historical electric
usage for the approximately 1,550 current low-income customers and the average amount
charged to resident customers for water, wastewater, and refuse services.
The partnership recommends this item be brought before Council for consideration on May
19, 2004, with a program initiation date of June 1, 2004. Mr. Lechner explained that the
proposed budget program would be $105,000, broken down as follows: $60,000 from
Electric Utility ($16,000 program administration, $5,000 customer outreach and materials,
$39,000 electric utility relief component); $30,000 Public Works water and wastewater relief
components; and $15,000 Central Valley Waste refuse relief component. The Lodi
Salvation Army, as program administrator/coordinator, would work with the Finance
Department to administer program funds.
Continued May 4, 2004
Mr. Lechner explained that the Salvation Army was brought into the process and is being
recommended to coordinate the program based on its experience as a leading organization
providing care and services to those in need. The Salvation Army currently administers the
PG&E Relief for Energy Assistance Through Commnity Help (REACH) program through 170
northern and central California offices and also administers the State/County Home Energy
Assistance Program (HEAP) program. The proposed $16,000 administrative fees paid to
the Salvation Army would cover eligibility and screening of customers, phone and personal
contact with applicants, and coordinating the billing system with the Finance Department.
Eligibility screening may include requiring proof of income of all residents, proper
identification of all resident occupants (driver's license, social security number), and other
criteria mirroring HEAP and REACH program requirements. Following approval, the
Salvation Army would report its findings and the amount of actual financial assistance to
the Finance Department to initiate the appropriate transfer of funds and to the Electric
Utility Department for follow-up. Either Mr. Lechner or Customer Services and Programs
Coordinator Kathy Brown would then contact the customer to coordinate a free, in-home
energy audit to assist and train residents in the use and conservation of energy and to
provide additional information with regard to refuse reduction, recycling, and
water/wastewater conservation opportunities.
Council Member Land asked how many programs customers can qualify for and how often
they need have to requalify. He also shared his concern for support programs evolving into
entitlement programs. Mr. Vallow explained that customers can qualify for the Single
Household Alternative Rate for Energy (SHARE) and Senior Fixed Income (SFI) (for
customers over age 62), as well as the recommended Lodi California Alternate Rates for
Energy (CARE). While little changes with regard to eligibility or income for SFI customers,
SHARE customer eligibility is reviewed about every two years. Lodi CARE recipients would
be reviewed each time they applied so no maintenance monitoring would be necessary,
only comparison monitoring at time of application. Mr. Vallow stated that customers can
qualify for all of these programs. Council Member Land stated he would support the free,
in-home energy audit and dissemination of information regarding other conservation ideas
being mandatory, and confirmed that these visits would meet the criteria for outreach public
benefit programs. Additionally, Council Member Land reported that statistics show that
17% of Lodi's population is in poverty level and Lodi is the second highest in San Joaquin
County, with Stockton being first. Most families receiving assistance are mothers raising
small children age 5 or under, and the majority of the problem is irresponsible fathers. He
stated that while he cannot regulate social issues, he can help low-income families and
seniors on fixed incomes with limited finances.
Mayor Hansen stated he sees the program as providing assistance should someone on
very low income be further burdened by a financial hardship such as an illness or medical
problem requiring new medications, making it a decision between paying their utility bill and
getting the medication and care they needed. The program would give them the opportunity
to apply for assistance in that type of crisis. Mr. Lechner supported Mayor Hansen's
comments, interjecting that the Lodi CARE program would not impact customers currently
participating in low-income assistance programs, but rather is geared to further assist
families and individuals struggling, as well as helping customers cope with financial
hardship or emergency situations. He stated he was surprised by Council Member Land's
statistics regarding the poverty level in Lodi and its status in the county, and stated he is
concerned that Lodi's high cost of rental properties and the lack of low-cost housing are
major factors, especially for single parent and single -income households.
At the request of Council Member Howard, Mr. Vallow further explained that Lodi CARE is
presented to supplement customers currently involved in low-income assistance programs
but still have difficulty keeping up on their bills. Many end up having their utilities turned off,
vacating the area, and leaving bills unpaid which must then be written off at year end. The
program is not for those who will not pay their utility bill, but for those who cannot, either
because of a low-income issue or due to an emergency or crisis situation.
W
Continued May 4, 2004
Council Member Hitchcock stated she was in favor of the proposed verification process and
supported the Salvation Army administering the program. She asked that specifics be
provided outlining the criteria to be used to screen applicants to ensure eligibility and how
the program will be monitored. Mr. Vallow shared that it will serve the City additionally to
have the Salvation Army administering the program, since it can use the data collected in
coordinating other programs to verify, monitor, and cross-check customer information. This
pilot program is not an ongoing discounted rate program, but a more immediate, short-term
solution to a crisis or emergency financial situation. He further stated that the City will
learn much about the diversity and needs of the community through its partnership with the
Salvation Army, and detailed that the dollars from the City to support the program will come
from Public Works and Electric Utility mandated funding, and that Central Valley Waste will
pay its portion of the program directly from its profits. Council Member Hitchcock stated
she supports the City's alliance with the Salvation Army for customer support programs
rather than giving the entire dollar amount which might be construed as the City making a
donation.
Council Member Beckman stated that he is not comfortable with the City coordinating
programs, but would consider giving the Salvation Army the $105,000 estimated customer
assistance budget to administer however it sees fit. Mr. Vallow stated that the City's billing
system lacks the technical infrastructure to allow for that, and as a pilot program, the City
wants a more hands-on approach in working with the Salvation Army to verify the
effectiveness of the program, from the initial application to the in-home information and
energy audits.
City Manager Flynn commented that prior to referring customers to existing programs, staff
attempts to work with customers in a crisis situation to determine if they can delay
payment or make payments over time to help them work through the crisis. The program
comes into play when this process repeats and becomes a social issue that the City is not
qualified to deal with. At that point the Salvation Army would step in with its experience
and expertise to handle the situation. He described the program where citizens could
donate funds to an account to assist other customers in need, with the Salvation Army
regulating it; however, participation was low, perhaps due to poor communication. He
stated that Lodi residents currently utilize several programs supported by the county, state,
and PG&E, but there is a lack of communication regarding program availability. Mr. Vallow
added that getting the word out is vital through literature, churches, civic groups, and
networking, aid staff believes that a check of the City's internal database will show that
approximately 1/3 of those who apply for Lodi CARE will be qualified to participate in the
SHARE program, but do not because they are unaware of its existence. This is another
way of getting people involved and getting citizens the assistance they need.
Tom Sanchez, representing Central Valley Waste Services, stated it participates in
programs such as Lodi CARE throughout the country and he is pleased to be involved in
partnership with the City to assist customers and provide information to conserve energy
and resources and to reduce refuse.
Serena Woods, representing the Lodi Salvation Army, described the qualification process
currently performed in screening potential fund recipients. Customers must complete a
prescreening form with all pertinent information, explain their situation and specific need for
assistance and their emergency or crisis situation. An internal investigation of the
application is completed, a follow-up phone call interview is made, and then a face-to-face
interview of approximately 30 to 45 minutes is conducted, at which time the client must
provide current proof of income, medical and miscellaneous bills, prescriptions, etc. that
support their financial situation and application.
Public Works Director Prima provided copies and a short eview of the City's current
discount program application forms, as well as a draft recommendation for a
Water/Wastewater/Solid Waste Utility Discount Program (filed). Mr. Prima stated he would
return to Council on May 19, 2004, to provide an outline of staff recommendations, including
Continued May 4, 2004
1) one unified set of criteria for program eligibility, 2) updated application forms to assist
customers in providing complete and detailed information for program consideration, 3)
program monitoring procedures with regard to continued eligibility and computer-generated
billing to clearly indicate customer costs and program funding resources, and 4) funding
estimates and budget sources. He stated that currently the Supplemental Security Income
(SSI) or Supplemental Security Payments (SSP) applicant process is simple in that the
customer completes it, SSI reviews and verifies information, and the form is returned to the
City to begin customer assistance; however, it is limited in its assistance to the customer.
In addition, b1ling information is currently listed as "other charges" and indicates various
discounts, but provides no details regarding programs, funding, and specific discounts and
charges to give a true and accurate picture of customer account activity. Additionally,
discounts do not apply to the entire bill, and staff recommends that this be revised.
Currently, rrarket cost is not included, and the rate increase a few years ago for water
wastewater iates has never been included in the discount. Mr. Vallow noted that many
customers would under normal circumstances be eligible for assistance, but landlords often
charge a fiat rental fee including utilities, which negates the renters from qDplying for
assistance.
Mayor Hansen preferred modifications to include offering customer discounts which apply to
the total utility bill, not just a portion. He stated that when contacted by a citizen recently,
they reported that their utility bill discount total was $2.15. Mayor Hansen suggested that
the percentage of the impact be reflected on the bill and that the statement modified with a
breakdown of billing, discounts, and program assistance details.
Council Member Hitchcock stated she liked the SSI/SSP monitoring process for its
efficiency and simplicity and would like to see the City's proposed process in detail to
include qualifying new customers and auditing existing customers for continued program
participation. She further stated that in qualifying for SHARE, which is based on federal
income guidelines, she believes the City can help more people with more funds than
through the SSI/SSP program, but also reflected that while even with all these
opportunities, some customers will still not be eligible for assistance because they cannot
provide the proper information for verification.
Council Member Land stated that if it were possible to retain the necessary information, a
good way to learn someone's true income would be to review their federal income tax filing,
which would show earned income, other income, and dividends. He further stated that in
following FIG Financial Advisory Services, the City of Lodi may be entitled to have access
to that information for verification of program eligibility.
Maxine Cadwallader, Revenue Manager stated that she is very supportive d the Salvation
Army's involvement in administering the program because many citizens are discouraged
and overwhelmed by the forms that accompany requests for assistance. She stated the
follow-up calls and personal interviews conducted by the Salvation Army as part of the
process will greatly assist the public and promote the program success.
D. COMMENTS BY THE PUBLIC ON NON -AGENDA ITEMS
None.
E. ADJOURNMENT
No action was taken by the City Council. The meeting was adjourned at 8:20 a.m.
ATTEST:
Jacqueline L. Taylor
Deputy City Clerk
al
Mayoes& Council Members7 Weekly Calendar
WEEK 0 F M AY 4, 2004
Tuesday, May 4,2004
7:00 a.m. -%irtsleeve Session
1. Lodi Care Package Program (EUD/PW)
5:30 - 7:00 p.m. Grand Opening and Ribbon Cutting of Robin's Nest, 665 West Turner
Road.
Wednesday, May 5, 2004
7:00 p.m. City Council Meeting.
(Note: Closed Session begins5:15 p.m.)
Thursday, May 6, 2004
4:00 - 8:00 p.m. Hansen. Open House of P. Gill Obstetricsand Gynecology Medical
Group, Inc., 999 South Fairmont Avenue
5:00 - 7:00 p.m. Hansen, Howard, and Land. LOE-Center 28th Annual Volunteer
Recognition social, 105 South Washington Street.
5:30 - 7:00 p.m. Grand Opening and Ribbon Cutting of Keys� Guild Street Grille and Bar,
171 South Guild Street.
6:30 -8:00 p.m. Hansen, Howard, and Land. Christian Community ConcemsGod and
Country Prayer Rally, Veterans Plaza, 221 West Pine Street
Frid a y, M a y 7, 2004
4:00 p.m. Special Closed Session Meeting.
Saturday, May 8,2004
10:00 a.m. 13pecial Closed Session Meeting.
Sund a y, M a y 9, 2004
Monday, May 10, 2004
Disclaimer. This calendar contains only information that was provided to the City Clerk's Office.
CADocurnents and Settings\jperrin Tocal Settings\Temporary Internet Files\OLKC4\Mcalndrl.doc
Filed May 4, 2004
Lodi City Council ShIrtsleeve Session
May 4, 2004
I
package wHI assist th:ese customers with paying
their monthly City of Lodi utifity bill
);i,- P ro posed sta rt d ate -. J u ne 1 1 2#04
I
�� A partnership has been created to fund andlor
coordinate this new program-.
City of Lodi Electric Utility
• City of Lodi Public Works
• City of Lodi Finance Department
• Central Valley Waste (C.V.W.)
0 Lodi Salvation Army
n
J
Proposed budget.- $105,000
;�> Several members of the partnership will fund the
* Electric Utility,-,
* Pubfic W*rks.-
0 C.V.W.M.
11
Pill
�� C.V.W. will fund the refuse relief component ($15,0000
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'"WIN MAL
This organization currently administers the
state/county H.E.A.P. program
A
Salvation Army is recognized statewide, an,*-"
nationally, as a leading organization providing carr-*
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and services to those in neeu
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Lodi Finance staff inputs information into billing
system
Salvation Army ALSO notifies Electric Utility of
approved customers
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UITY HALL� 221 WEST PINE STREL
LODt, CA 95240
(209i 333-6700
FAX (2-09) 333-6807
APPLICATION F -OR
REPUSE RNIFE REDUC FION ol- BACKYARD SERVICE
NAVU." TELEPHOINIE: (209)
E, - -----
07� CLERK
Crr� AT-rORNEY
A D �D F� I -SS LODl, CA 9524
N NIBER OF PERSONS LIViNG AT RESIDENCE:
CITY OF LODI VVILITY ACCOUNT NUMBER -
'pi -ase inoficate by box(es).-
am d�.sabled andneed "backyaFd" sewice, The �rash collector will ro�! m y carl(s) to the truck,
in� rny householcl �,s capaole of Ploving ffie� carik(s) to the, curb,
ATTAGH APPROPI"IATE PROOF OF DISABILITY such �is a frorn your
ph,17'-S�Nciap, of anv cardfletter identifying you as a disabled pe�son,
f a iz n a'
oi -�duc�ion in the �esidc Rrefills,�- col�ection ra�e due Lo pem nal
econor-nic� hardship. -1-otal inco-me frorn all saurc-es and all persons at residemce:
�.)ef yezill,
NOTE-, You n,fus, rinleef, criteria establisned by the City of Lodi �o qualify as a low-income earner and
recck, a I-ak, -eduction,
PLEASE ATTArH PROOF OF F-L'GIBILITY such �IS SUPpi ' I
emental Security Incomo (SSI),' state
Supplemental Payments (SSP), TemporaTy Assistance to N(,,cdv Families (TANF), a copy of a
Social Security chock, or other QPP,Lopriate documentation,
1 �--ertify the above inlfovma�ion is krue and correct.
SIGNATURE':
DATE,
Rutum thi5 form wiIh dggj.mQn ( i (ion proof to 1,43MY-11riaro, Lodi Ci',y Hall, Z21 W, Pine St, PO Sw-, 3006, Codi, CA 95Z41-1910,
if you My- quWions, pie-aso F,107Tei�—a(ayn at (209)-333-6793. if you reach the 4 'llig
nswn� Marhino, please 4"aw a Mergaga
Dt'd vour coU v;'M be rutu-med as voon as pos�blo,
SSI & SSP RECIPIENTS
YOU.MAY QUALIFY FOR A
WATER,.SEMR, AND REFUSE RATE
LOW: INCOME DISCOUNT
City of Lodi Finance Department
City H8.11. Annex
212 West Mine Street
Lodi,califorilla
Telephone:: 209/333-6719
... . ..... ... ... . .. ..... . ... ... ...... ...........
Information Release Authorization City of LodiFinance Department
-------------- ---------------- - --------- -- ----------------------- ------------ -----
Ustomer Naryle'. Telephone Number,,
pplication Date:
----------- ------ ------- ------------------
------------------ - ------- -------- -------- -------
Social Security Number: Utility nber:
Acmujit. Nua
--------------- ----------------- ------ ---- ---- ------- ----------- ----------- ---------- --------- ------------- --------------- ------ ------
-----------------
Customer Street. Address:,:Cty, State, Zip CmIO,
------- ---- ----- ---------------------- ---------------- ---- - -------- ----------- -------
I hereby authorize the Soc0l. Security Admin[stration to rQ�ea5e my SST or SSR eligibility: status. arid residehw addrez to
the Cit Lod�
CUSTOMER ST.GNATI URE�.,� x
Do -nat vxite bdvn ths �he� Vor.sor�al s
T ation. Please verify that this person is. gible for S51:6r SSR
o Social Security Administr :eli L1. :Yes 1 a No
----------
When completed, please. return to,
City of Lbdi-Ffnan.ce b.ep.arLment:
Po�t Offic(�:Box 3006
Lodi (2'aliforni,a OV4.1�1910
---------- ---------------- -
.Verified by.
F. -SSI SSPLohl h-IM30 DISC(74117tr-l�,'Orand,�ppilcatton RPV15ed 10 19.00'doc
cvtaber I pi:p000
PaPp I of I
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Name — As it
W -
City of Lodi — Senior Fixed Income
Residential Certification Application
of Iketord Account
on your City of Lodi
— Do NOT Use a P.0, Box
addrcss;
— (for example 12345)
P101W4
mber- (Area.Code first)
XMTARn�
Senior Fixed Income Discount Guideline
Your househotdis gross.inWnle mw hot oxceed $45,W0 annually AND you must be over 62 years of age. Fixed incorne must be the
Mkjority (at lew�t 801/1o) of total income. The intent of this program is to give a discountto customers who primarily are on a fixed
incornp, and are's'enior citizelm Qualified applicants are not eligible for any other discount by the City of Lodi for their el.ectric bill.,
To qualify the fbilowing chocklist must be followed:
Applicant must be the City of Lodi Cu,�tomer of Record,
Applicant may not bc claimed as a dependent an anothor person's tax retum.
Applicant mWt at(ftch tolbis application documontation. showing tha current income for all people. living: in the, home doesnot exceed ft
iocome guidelino HmiK Application is considere-diAcomplete wi thout (See back. f0T example-, of Proofof hicome).
Applicant Must notify the City of Lodi Fitlanco. Departmatt within 30 days of. becoming.inefigible for this discount,
"Fixed lacofflo of Hou"
sonold" means all moncy wid nosi-c&-,h benefits, %vailable f6r living exponse.5, kow all fixed income, both taxable and non-
taxablc' lx�fory doductions fol all people wbo live in my home, Ibis is 'limited to: Child/Spou.sal support; Intertst dividends.ar witIldrawals ftom
ocial Security; Veterans, disability or
acc.ount�' or retirement accounts such as IRA, pensions, retirement accoulits and 401K acvounts; S..
anemploynlpn� benelfts andwarkers compensation: AFE)C,, SSI; SSP, Cash public, assistaftee; Food Stamps and fr6� housing or utilitics, School
gmnts,'�oon� wholarships, or othcr aid,
InQom�,, consider-od ni�t fl=,d irtcludes but i's not Hmit�.d to illo followinx. wage anti salary income, commissions, business income, gains and inct)me
froln stock; 1-yonds, property W'd other assets, lottery and non retimment plan annuities.
The Fixed Income Worksheet on the reverse must be completed to prove income qualificatie".
By signiog belovv� I cvrfif� ander Pe"214, of perj ury 0 sat the above provided information is true and correCt under the lowsof tbe:State of
Cal&rnia, I understand that: the Gtv of Lodi reserves the right to request verification of Continued monomid. need at zoy thue, and I will
oofify the City of Lodi Finance Do artment of any changes that affert my eligibility. I understAnd that the City of Lodi has tile right to re -
P
bilk me at the applicable rate if appropristte.
City of Lodi Customer of Record Signature El (,�fieck if guardian or power of attorney
CITY OF LODI. CUSTOMER SERVICES 209-333-6719
City of Lodi - Senior Fixed Income
Residential Certification Application
CITY OF LODI Fixed Income Worksheet Pleaso Tvn,
GROSS YEARLY FIXED INCOME OF HOUSEHOLD
4 -AFDC S
+Food Stamps
+SSI / SSP
+SSA
+ Pensions / An n ufty/40 I k/IRA S
Income S
Total Fixed Income (sum ofabove) S
Total Annual� IncoRpe (add A& R)
Line Abovc X 80%
Must Be-, Included With
GROSS YEARLY NON -FIXED INCOME
+Wages/Commissions
+Stock/Bond Income*
+Bosincss Income
+AIJ Other Income S_
Total Non -Fixed Income (sum) S
(A)
(Must be less than $45,000 to qualify)
(Une A must be greater than this line to qualify)
*Outside Retirement Planssuch a,5 401k, Company sponsored plans
LIA,struction Sheet
This prograin provides -for a monthly dlycount of 5% on your City of Lodi Electric Bill, The City of Lodi witl u,50 the completed
application, 14qng with income documentation you provide, to determine if your household ineels the follow fued income
Ing
guidefln&s% Shouldyou qualify, your discount will appear as soon as practicable after the completed applierdion has been received
andverifted. The Cify qfLadi will occasionally contact you to verify that your needfor the program has not changed,
proorof Income
The City of "'odi will use documenhation you provide to determine whether your household qualifies under the income guidelines listed
above. Kou must submit CURRENT PROOF OF INCOME for everyone: receiving money inyour household. Your4p
plication is
considercd incollnplwe without this documentation. The City of Lodi will contactyou fbr upddied inconze information . if your
docu"Zonlation is incomplete or not current,
Mile foUowing are_�Laqlgjqs of documentation you can submil as proof of your household income.
Agency Assistance: Intake documentation from loi�al agency showilig household income and agmicy comact information.
Aid to Families with Dependent Children (AFDC)-. Notice of Action; Computer printou
t; Benefit letter; Copy of check.
• Child and !or Spoosal Support: Copy of che-ek,
• Disability Compeo5ation, Copy of current check; Printout from agency or insurance company verifying amount.
Federat Tax, VomA 1040 and accompanying worksheets (Schedulo C, F, and Form. 2555); Forms W-2 for all wage earners.
Genera� Assista nee, Notice ofAction from County Social Services;
Copy of curront chock.
Interest Income- Monthly or quarterly bank statenicnt; Statement of interest income froin bank or agency.
Pav Check Stubs: Current stub(s) covering at least two months and showin TrOss IT)c
96 Onlc�
Peasion and Annuities- Copies of current check; Annual statement frorn ponsion plan.
Self-ernplbyed- Foderal Tax Forms 1040 and Schrduie C� Two recent bank statements showing personai income.
Social Seturity, Copy of current check(s); Notification from bank of direct deposit.
Supplemental Security 1wome (SSI), Notice of Planned Action; Notification from bank of direct deposit.
Supplemental Security Payment (Ssp); Notice of Planned Action; Notification from bank of direct deposit.
Stadent Aid. Financial Aid statement from College or University.
Support. frow an individual. Copy of check and stati�rnent signed by pet -son providing support.
Uuemploymeat Bvnefiats� Copy of current check, Printout from Employment Development Depadmeut,
Vcterau.'s:Benefitsz A letter indica6s)g �etejpt Df Vcteran's Pension; Copy of VA chmk.
OtherSoumsoffrwome, Documentation of'offier money received by your household and used to pay your monthly bills.
PLEASE NOTE: Unaltered docunients should be submitted. Originals will not be returned.
CITY OF LODI CUSTOMER SERVICES 209-333-6719
SHAM` "Gross Ye-arly Inw, mr, of IiDuqehold" weam aH monoy mid non-owh hemflK availa.ble for living expenses, ftrn all �Qurccs, both taxable
mid dQduaions forall people who live in my home, This includes, but N Dot hatited to�
V Wag�n, salaries and commissions; Self�
employrnQnt.- Child/spousall. . support, ffiterost divicicnds or withdrawals ftorn savings accounts, stock-, and bonds, or retiremmi wcounts suck as IRA
�wd 40 1 K -accounts, Stockj�- Bonds-, Business or tucntal income, support from family or friends-, Cash gills, loans; Lottery winning,5, Tax mfunds,
md moncy fiom insurance polkies or lcgal s.cnlomQnis; Social Scfurlty-, Retireinent, veterans, disability or unemployment bencfits andworkers
conipensation, AFDC, SSYK SSP, 0�sh pobfic assisuxnc�-, Food Stamps and free housing or Utilifics; Scho0i grant$, loans scholatships., or other aid,
GROSS YEARLY INCOME OF HOUSEHOLD
AFDC S + Pensions /Annuity
f- Food Stamps $ + Wages
* ss, f: / SSP S + Interest Income
* SSA $ + Other Money used to Pay Bills $
= Total Income S
By signing below, I Certify Ian er penalty
.d df perjury that the abuve provided information ig true and correct under the. lows.of tht State of
California. I vadev000d that the City of Lodi reserves the right to request YON(Iteation of continued ecoom . Ric need at any time, and I will
noti�y the Citylof Lodi Fknan� w Department of any changes that affect my eligibijiq� I understand that the City of E�odihas the dght to re -
W11 "m at 113e applicable rate it Appropriato� 1 understand that this inrormation may beshared with my otheir energy utility-, if applicable.
City of Lodi Custorner u - f Reeord Signature El check if guardian or power of attomey
C ITY OF LODI CUSTOMER SERVICES 209-333-671.9
City of Lodi - Single Household Alternative Rate for Energy (SHARE) Prograni
Singte Fanfily Program
, "'nc"Ose p r
9 '41 is an application for the Sb��gle Household A Iferna4a Rates for Ei nergy (SHARE-) Program. This program rov.jdev fo a
mom hly dis couni of 2 0% on your Cily of Lodi Electric Bill, The City of Lodi will use the completed application, along with income
documentaiion you provide, to deii�rtnine i(your household ineets thefollowing income guidelines. 3houldyou qualify, your discoun't
will appear as soon as practicable after Me completed application has been received and verified The City of Lodi will occasionally
rontact vou to verifi, thar your needfor the program hasn'f changuii
SHARE INCOME, GUIDELINES
Your household's gross income must riot exceed the SHARE Income Guidelines
Number of Persons in Rmisehold Maximurn _AnnualHouschold Ineome
1-2 $ V,060
3 $ 25,900
4 $ 31J00
E,achadditional rl $ 5,200
Proof of Income
71he Ci(y Qf Lodi will ase documenlationyou providew determine whetheryour householdqualijies under the income guideli.nes lis.ted
above. You. must subm.ii CURRENT PROOF OF JAICOA16: for everyone receiving money in your household. Yourapplication is
conyidered i�ncoirp0e ivithoul this documentation. The City of Lodi will contact you for updated income information if your
documentation is incomplate, or aot current,
The following are of docunwmation you cansubmit as proof of your household income:
* Agency Amistancm Intake documentation fi-om local agency showing household income and agency contact information.
* Aid to Families with Dependent Children (AFDC)., Notice of Action; Computer printout; Benefit letter; Copy of check,
* Child and/or Spousal Support: Copy of check.
* Disabili ty Compensation: Copy of cw-rent che,�;k; Printoa ftom agency or insurance. coMpany Yerifying amount
* Fcdcral.Tax. Forin 1040 and accompanying workshuets (Schedule C, F, and Forni 2555); Forms W-2 for all wage camers.
* General Assistance. Notice of Action frout County Social Services; Copy of current check.
* Interest Income,. Monthly or quarterly bank statement; Stateruent of Wtcrc5.t income fiom bank or agency,
Pay Check StubF,. Current stub(s) covering at loast two months and showing gross income.
Pension and Annuities: Copies of cuirent check-, Annual atatenicnt from pension plan.
Self-employed, Fedoral Tax Forms [040 and Schedule C; Two recent bank statements showing personal income.
SoOW Security� Copy of currunt check(s)-, 'Notification fTom bank of direct deposit,
Supplemental Security Income (SSI)� Notice of Planned Action, Notification from bank of direct deposit.
Supplemental Security Payment (SSP): Noticf, of Planned Action; Notification from bank of direct deposit�
Student.Aid� Financial Aid statement from College or University.
Support frow an individual: Copy of check and statement signed by persou providing support.
Unemploymeat 0enefits. Copy of current olieck; Printout from EmploymQnt Development Department.
VeieraWs Benefits: A letter indicating receipt of Veteran's Pension; Copy of VA check.
Other Sources of Ulcorne: Documentation of other money received by your household and used to pay your monthly bills.
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CITY OF LODI CUSTOMER SERVICES 209-333-6719