This Deferred COVID-19 Payment Plan Arrangement (DCPPA) is an agreement by the account holder and/or current resident to reconcile a delinquent utility account.
Effective September 30, 2021, the Washington State Water Disconnection & Late Fee Moratorium (Proclamation 20- 23) expired. This proclamation did not relieve customers from the obligation to pay for utility services nor will utility charges be discounted or waived. The City of Gig Harbor cannot gift public funds under current state law. For payment assistance beyond a DCPPA agreement please call 211.
Once this form has been received, a Utility Billing Technician will follow up with your request. Filling out the form does not guarantee a payment plan arrangement.
**If this is a rental account, a copy of this Agreement will be sent to the property owner (or management company acting on the owners behalf). The City is not responsible for any fees or penalties that may be charged by the property owner (or management company acting on the owners behalf).
I have been unable to pay the past due balance on my account because of the financial hardship resulting from the COVID-19 Pandemic. Therefore, I am formally requesting that I be considered for inclusion in the City of Gig Harbor’s Deferred COVID-19 Payment Plan Arrangement.
I am aware that I may be required to provide financial information and other documentation to establish eligibility. I also agree that the City of Gig Harbor may contact me at the phone number, email or address provided.
I hereby accept the City of Gig Harbor’s offered extended payment plan, and understand and agree to the following by signing and dating this arrangement form below:
I certify, under penalty of perjury, that all statements on this form are true and accurate to the best of my knowledge. I understand that this arrangement may be revoked if I fail to notify the City of changes to my financial situation or living arrangements, if I have provided false information or fail to meet payment arrangement terms. This could result in associated fees being assessed, termination of utility services and/or further collection actions which may include a lien placed on the property.
This field is not part of the form submission.
* indicates a required field