Close
Upcoming Events
A-Z FAQ
Programs & Classes
Job Opportunities
Latest News
Press Releases
Map Anything
pay utilities
newsletter
contact us
Resident Resources
COVID-19 Updates
Cemetery
Fire Department
Garbage & Recycling
Parks & Recreation
Pay Utility Bills
Police Department
Public Works
Report a Problem
Streets & Lighting
Upcoming Events
Construction Projects
Water
Business Resources
Building Department
Business Licenses
City Purchasing
Code Compliance
Economic Development
Engineering
Planning & Zoning
South Jordan Chamber of Commerce
About Sojo
City Life
Contact
Gale Center Museum
Get Involved
Job Opportunities
Latest News
Moving to SoJo
Our Story & Vision
Press Releases
South Jordan Arts Council
SoJo Summerfest
Government Resources
City Departments
City Manager
Contact
Courts
Elections
Finance Department
Mayor & City Council
Meeting Agenda & Minutes/Archive Center
Municipal Code
Planning Commission
Public Notices
Public Records
South Jordan Strategic Priorities
Search
Menu
A-Z Faq
About Us
City Life
Contact
Gale Center Museum
Get Involved
Job Opportunities
Latest News
Moving to SoJo
Our Story & Vision
Press Releases
Business Resources
Building Department
Business Licenses
City Purchasing
Code Compliance
Economic Development
Engineering
Planning & Zoning
Government Resources
City Departments
City Manager
Contact
Elections
Finance Department
Mayor & City Council
Meeting Agenda & Minutes/Archive Center
Municipal Code
Public Notices
Public Records
South Jordan Strategic Priorities
Job Opportunities
Map Anything
Newsletter
Resident Resources
Cemetery
Courts
Fire Department
AED
Becoming a Firefighter
Contact the Fire Department
Feedback
Training and Courses
Garbage Service
Upcoming Events
Parks & Recreation
Event Permits
Fitness & Aquatic Center
Mulligans Golf & Games
Parks & Trails
Programs & Classes
Senior Services and Community Center
Pay Utility Bills
Police Department
Animal Services
Community
Online Crime Report
Recruitment
Report Crime Online
Victim Services
Public Works
Report a Problem
Streets & Lighting
Water
AED Rebate Form
AED Rebate Application
INSTRUCTIONS FOR COMPLETING AND SUBMITTING THIS APPLICATION: Applications must be submitted electronically and by the date and time listed in the Guidelines. Applications shall only be received from the owner or occupant of a private building located within the geographic boundaries of the City of South Jordan, required to comply with South Jordan City Ordinance 8.32, Project Cardiac React, and meeting the rebate eligibility requirements as outlined in the City of South Jordan AED Rebate Guidelines (“Guidelines”). An itemized copy of the purchase receipt must be included with the application. All sections of this application must be completed. Incomplete applications will be rejected.
Step 1 of 3
33%
Section 1: Identifying Information
ELIGIBILITY (TYPE OF ENTITY):
*
Licensed health care provider
Assisted living or care center
Child care facility with an occupant load of greater than 50 people
Fitness center or swimming pool of one-thousand two hundred square feet or larger
Dental office
Municipal or private golf course
To assist with verifying eligibility, check the appropriate box to identify the type of entity which describes where the AED is located.
Entity Legal Name:
*
Mailing Address:
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Telephone
*
Fax:
Federal Tax I.D. Number
*
Primary Contact - Name:
*
First
Last
Mailing Address:
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email:
*
Telephone:
Cell Phone:
Fax:
Secondary Contact - Name:
*
First
Last
Mailing Address:
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email:
*
Telephone:
Cell Phone:
Fax:
Address of AED:
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Physical Location of Rebate Funded AED in Building/Structure:
*
(If more than one AED) Physical Location(s) of Rebate Funded AED in Building/Structure:
SECTION 2: REQUEST
ITEMS PURCHASED - COST:
AED
AED Electrodes
AED Batteries
Wall-Mounted AED Cabinet
Wall-Mounted AED Sign
Only include eligible purchases for which you are requesting reimbursement in accordance with the rebate guidelines.
Reason AED Purchased:
*
Initial Purchase
Replace AED (eligible once every 15 years)
AED Manufacturer:
*
Quantity (limited to quantity required to meet the ordinancy):
*
Actual Unit Cost: (AED only - without batteries, pads, or other items)
*
Eligible Rebate Amount: (Maximum rebate is $975 per unit)
*
Reason AED Electrodes Purchased:
*
Initial Purchase
Used on patient
Expired or damaged (eligible once every five years)
AED Electrodes Manufacturer:
*
Quantity of AED Electrodes:
*
(limited to one per AED)
Actual AED Electrodes Unit Cost:
*
Eligible Rebate Amount for Electrodes: (Maximum rebate is $140 per unit)
*
Reason AED Batteries Purchased:
*
Initial Purchase
Used on patient
Expired or damaged (eligible once every five years)
AED Batteries Manufacturer:
*
Quantity of AED Batteries:
*
(limited to one per AED)
Actual AED Batteries Unit Cost:
*
Eligible Rebate Amount for Batteries: (Maximum rebate is $60 per unit)
*
Reason AED Cabinet Purchased:
*
Initial Purchase
Replacement (eligible once every 20 years)
Quantity of AED Cabinets:
*
Actual AED Cabinet(s) Unit Cost:
*
Eligible Rebate Amount for Cabinet(s): (Maximum rebate is $175 per unit)
*
Reason AED Sign Purchased:
*
Initial Purchase
Replacement (eligible once every 20 years)
Quantity of AED Sign(s):
*
Actual AED Sign(s) Unit Cost:
*
Eligible Rebate Amount for Sign(s): (Maximum rebate is $45 per unit)
*
SECTION 3: CERTIFICATIONS & ASSURANCES
By submitting this rebate form I certify: The rebate requested is for a Public Access AED, or other related and eligible items, located and mounted as required in South Jordan City Ordinance 8.32.
*
Yes
No
The name, address and phone number of the AED owner, and the exact location of the AED, has been reported to Valley Emergency Communications Center (VECC) at http://www.vecc9-1-1.com.
*
Yes
No
The AED owner understands he/she is required by law to encourage individuals who are likely to use the AED to complete a course on the administration of CPR and the use of an AED.
*
Yes
No
The AED owner will maintain the AED in accordance with manufacturer recommendations and applicable federal, state and local laws and regulations.
*
Yes
No
Submitted by:
*
Telephone:
*
Upload a copy of your receipt(s)
*
Drop files here or
Captcha
Comments
This field is for validation purposes and should be left unchanged.
Share this:
Facebook
Twitter
Pinterest
Sign up for the sojo newsletter and other email notifications
Sign Up