Form — Home Weatherization Application - Salish and Kootenai Housing Authority

The Montana Department of Public Health and Human Services (DPHHS) and The NorthWestern Energy (NWE) and any Federal Agency or Utility WEATHERIZATION ASSISTANCE PROGRAM(S) ACCESS AGREEMENT

Occupant*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

We, the undersigned agree to participate in the Department of Public Health and Human Services (DPHHS) Weatherization Assistance Program(s), the NorthWestern Energy (NWE) Free Weatherization Program and/or any Federal Agency or Utility funded weatherization programs. The Primary Weatherization Contractor will be:

Contractor/Agency Name

Address

Street Address Address Line 2 City State ZIP Code

We understand*

We understand that appropriate energy conservation measures will be installed in our home free of charge by weatherization contractors who will exercise care not to disrupt our household more than necessary to complete the weatherization work. We further understand that DPHHS, NWE and/or any Federal Agency or Utility do not guarantee the work of the weatherization contractors and as consideration for providing the weatherization work at no charge, we agree that our only recourse in the event of any defects in workmanship or materials related to the installation shall be against the Primary Weatherization Contractor listed above.

We agree*

We agree to hold DPHHS, NWE, any Federal Agency or Utility, their officers, agents and employees harmless from any and all claims, demands, actions and causes of action for damages to the property or injury to persons, debts, liens, obligations and liabilities of every kind and character whatsoever, in law and equity, which we may have or assert resulting from, or in connection with the weatherization work.

We know*

We know that during the course of the project it will be necessary for a number of contractors to make visits to our home to install cost-effective conservation measures and for the Primary Weatherization Contractor, DPHHS, NWE, any Federal Agency and/or Utility representatives to have the right of inspection before and after the installation of the energy conservation measures. We agree to provide reasonable access to those individuals involved in the project upon request.

We understand*

We understand that the sole purpose of the weatherization project is to reduce household energy consumption by performing measures prescribed by the Savings-to-Investment Ratio (SIR) computerized energy audit.

We agree*

We agree the installed weatherization measures and any appliance(s) (e.g., furnace, refrigerator, microwave and/or clothes washer) are to remain with the home and the landlord and/or the owner assumes all responsibility related to them, including maintenance.

We understand*

We understand that the Primary Weatherization Contractor will provide a copy of this agreement to the occupant, tenant, owner and/or landlord.

We understand*

We understand that no undue or excessive enhancement will occur to the value of the dwelling as a result of the weatherization measures funded through DPHHS, NWE, any Federal Agency and/or Utility Weatherization Assistance Program(s).

We certify*

We certify, to the best of our knowledge, this property is not scheduled, within the next 12 months, for sale or for acquisition or clearance under a government program.