INSTRUCTIONS FOR APPLICATION

Transcription

1 INSTRUCTIONS FOR APPLICATION PLEASE DETACH AND RETAIN THIS INSTRUCTION SHEET FOR YOUR RECORDS In order to become an eligible a participant in the Make Oak Ridge Energy Efficient (MORE 2 ) program you must complete and return the attached application during a scheduled interview along with any required documentation. Submission of a complete application and all required documentation does not guarantee participation; additional criteria for eligibility and selection for participation is based on MORE 2 program guidelines and the requirements of the TVA grant funding MORE 2. Minimum Qualifications: Home must be within Oak Ridge City Limits Home must be at least 20 years old (Built before 1996) Home must have electric heating The total household income of participants during the previous calendar year must not exceed the limits established by the Department of Housing and Urban Development (HUD) for low-income guidelines for Anderson and Roane County as shown below: FY 2016 Low-Income Limits Number of People in House 1-Person 2-Person 3-Person 4-Person 5-Person 6-Person 7-Person 8-Person Anderson County $34,650 $39,600 $44,550 $49,500 $53,500 $57,450 $61,400 $65,350 Roane County $30,350 $34,650 $39,000 $43,300 $46,800 $50,250 $53,700 $57,200 WHAT TO SUBMIT 1. Fully completed Page 1 and Page 2 of this Application 2. Proof of current Total Monthly Household Income from occupants age 18 and older. (e.g.: previous year s Federal Income Tax return, pay stubs from the last 30 days, and/or an annual benefits statement for the current year) 3. Proof of payment of previous year s City and County Property Tax 4. Proof of Homeownership/Warranty Deed 5. Photo Identification for homeowner & all household members above 15 years of age 6. Most recent electric bill 7. Last three months of bank statements FOR RENTAL PROPERTIES ONLY: 8. Fully completed Page 3 of this application 9. Non-Refundable $25 application fee The applicant is expected to bring each of the required documents listed above to the interview. If copies of each of the required documents are not received with the completed application at the time of submission your house will not be considered for participation. Submission of a complete application, required documentation, and/or fee (if required) does not guarantee approval to participate in the program. WHERE TO SUBMIT THIS APPLICATION In order to submit your application, you must make an appointment for an interview by calling (865) ext.109. At the time of your interview, bring completed application and all supporting documentation to: Aid to Distressed Families of Appalachian Counties (ADFAC) 1051 Oak Ridge Turnpike, Room 203 Oak Ridge, TN You cannot submit your application online. FOR ADDITIONAL INFORMATION OR TO ASK QUESTIONS: Please visit our website MakeOREE.com or contact MORE 2 Help Line at (865) These numbers will be given to you in your interview and will help you track your status along the way Applicant ID: House ID: It is against the law for this recipient of Federal Financial Assistance to discriminate against any individual in the United States, on the basis of race, color, religion, sex, national origin, age, disability, political affiliation, or familial status. Any customer who feels he/she has been discriminated against and whose complaint has not been resolved should contact the administrator of this program: Bruce Applegate, City of Oak Ridge, PO Box 1, Oak Ridge, TN 37830, ( bapplegate@oakridgetn.gov)

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3 Applicant Name: Address: Home Phone: Mobile Phone: Other Contact: Address: APPLICATION FOR PARTICIPATION PAGE 1 For Office Use Only: (Do Not Mark in this box) Completed Application Received: / / Date Interview Complete: / / Application Status: Eligible Denied Applicant ID: House ID: REQUIRED HOUSEHOLD INFORMATION, LIST EVERYONE LIVING IN THE HOME (USE SUPPLEMENTAL INFORMATION FORM IF NEEDED) Name (First and Last) Date of Birth Social Security Number Gross Monthly Income (List the amount and source of each income type) Applicant: What year was the home built: INFORMATION REGARDING YOUR HOME Approximate size of Home in Square Feet: What is the Main Source for Heating? Electric Gas Number of bathrooms in your home: What type of water heater is in the home? Electric Gas Number of bedroom(s) in your home: The applicant is: (Check only one) the owner occupant. the owner and landlord the renter of this dwelling unit. Other-Explain:

4 APPLICATION FOR PARTICIPATION PAGE 2 APPLICANT CERTIFICATION: I certify the information contained in this application for assistance from the Make Oak Ridge Energy Efficient (MORE 2 ) program is true and correct to the best of my knowledge. If my home located at the address on Page 1 is selected for participation in MORE 2 program, I agree to comply with all project guidelines in a timely manner. I agree, fully and voluntarily, to background checks related to the criminal history for all household members listed. I certify that all liens on the subject property being considered for inclusion in the MORE 2 program have been disclosed and that all required payments against these liens are all current. I understand that failing to meet the established guidelines may result in disqualification and any further consideration of my application. I understand that the results of these background checks and the accuracy of my application will be used only as the basis for an application decision and will not be shared with any individual or organization outside of the MORE 2 program. I also certify that I am aware that providing false information on this application or conducting unlawful activities at my home during the time of participation in the MORE 2 program may automatically and immediately disqualify me from further participation and may require me to a repay any funds spent on my home by the program. Signature (Applicant): Date: Signature (Witness): Date: RELEASE OF INFORMATION I, hereby authorize the release of the information contained in, attached to, and (Print Name of Applicant) referenced in this application to the following agencies and entities for purposes of determining eligibility, evaluation of energy efficiency potential, and gathering data in relation to the MORE 2 program: Aid to Distressed Families of Appalachian Counties (ADFAC); City of Oak Ridge (COR); Gilmartin Engineering Works (GEW); StrataG; Tetra Tech; and the Tennessee Valley Authority (TVA). Signature (Applicant): Date: Signature (Witness): Date: RELEASE OF CITY OF OAK RIDGE ELECTRICAL DEPARTMENT (CORED) UTILITY RECORDS I, hereby authorize the release of information pertaining to, (Print Name of CORED Account Holder) (Account Number) my CORED account, both past and future to TVA or its authorized representative(s). I understand that this information will be used only to provide data that may validate the effectiveness of energy efficiency upgrades to my home and the information obtained through this release shall not be made public in such a manner that the dwelling or occupants may be identified. If the energy bill for the residence is not in the applicant s name, the person whose name is on the account must sign. Signature (CORED Account Holder): Date: OWNER PERMISSION FOR WORK I, am the owner of the home located at the address listed on Page 1. By signing (Print Name of Home Owner) this form, if my home is selected for participation in the MORE 2 program, I am giving my permission to allow work to be performed on this home with the following provisions: (1) the unit will be evaluated and inspections performed, both before and after installation inside and out; (2) energy efficiency measures, as determined appropriate by the project personnel, will be installed; (3) supervision of installation; (4) access to the home for follow-up inspections of the work; and (5) I will reimburse the MORE 2 program for any funds spent on my home in the event of my failure to comply with program requirements as agreed. I agree to cooperate with TVA and its authorized representatives in performing evaluation, measurement, and verification (EM&V) of the Project. Information obtained or accessed for EM&V may include, but is not limited to; electricity metering data; onsite verification of installations and project compliance. All information collected will be held in confidence and will be used by TVA or its authorized representative for project analysis purposes only. I also agree to ensure that TVA or its authorized agents have access to the home/dwelling unit at reasonable times, for a period of five (5) years from the date of the project s completion under this agreement to the entity performing EM&V activities. Signature (Home Owner): Date:

5 APPLICATION FOR PARTICIPATION PAGE 3 ONLY REQUIRED FOR RENTER OCCUPIED HOMES Home Owner and Renter Agreement: This Agreement is made and entered into this day of, 20, by and between, hereinafter referred (day) (month) (year) (Home Owner or the Authorized Agent) to as the Owner, and the City of Oak Ridge, hereinafter referred to as City. This Agreement is for the provision of work solely at the rental property at the following address: Oak Ridge, TN The agreement in no way commits or requires the city, or any other party (address & unit) contracted by the city to execute the MORE 2 program, to perform work at any residence, nor is it a guarantee work will be performed at the address listed. The Owner (or the duly Authorized Agent if so appointed by the Owner) agrees to the following conditions in order to participate in the MORE 2 Program: [1] The benefits of the MORE 2 program upgrades provided at the subject property, quantified as energy cost savings, shall accrue to the low-income lessee; [2] The rent for the subject property shall not be raised for a period of two (2) years from the completion date of the upgrade work, unless the increase is already part of the current rental agreement or the increase is demonstrably related to matters other than the work performed related to the MORE 2 program. This rent freeze remains in place for a period of two (2) years from date of completion of the MORE 2 program upgrades, even if the lessee no longer resides at the subject property; [3] The Owner (or authorized agent) agrees that the lessee of the property will not be evicted without legal cause (e.g., non-payment of rent, etc.) for a period of two (2) years from the date of the completion of the MORE 2 program work; [4] All upgrades (i.e., installed energy conservation measure or features, as well as all associated connections and controls) installed at the subject property shall remain affixed to the property and be properly maintained and operated for a period of five (5) years after the completion of the MORE 2 program or for the typical life expectancy of the upgrade, whichever is longer. [5] If a complaint if logged against the Owner by the lessee of the subject property regarding a proposed rent increase (not included in an existing rental agreement), eviction action without legal cause, removal or disabling of an installed upgrade, or any other hardship imposed upon the lessee by the Owner as a result of, or associated with participation in the MORE 2 program is received by the City of Oak Ridge, the Owner (or authorized agent) agrees to immediately provide the City upon request, written information that the terms of this Agreement have not been violated; [6] There is no known plan for government acquisition or clearance of the property identified above within 12 months of completion of the MORE 2 program; [7] Permission is granted by the Owner for the City and/or its agent(s) to conduct, or to make arrangements for the following activities to be conducted at the property: [a] Evaluation and inspection of building interior and exterior; [b] Installation of energy conservation measures (ECMs) as authorized; [c] Supervision of ECM installation contractors; [d] On-site inspection of all completed work; and [e] Such other particulars or requirements as may be attached to this Agreement. [8] In the event the subject property is sold, the new owner shall be bound by the terms of this agreement unless no MORE 2 program work has been performed at the time of the sale closing and the new owner revokes this agreement in writing; [9] The terms of this Agreement shall be binding on the parties hereto, their heirs, executors, administrators, representatives, successors and assigns; [10] The Owner, or the Owner s Authorized Agent agrees to pay a $25.00 non-refundable, one-time application fee for the subject property to be evaluated for inclusion in the MORE 2 program. [11] If this property is currently enrolled as a Section 8 property [as defined by Section 8 of the Housing Act of 1937 as amended (42 U.S.C. 1437f)], a copy of the current Section 8 Agreement must be included as an attachment to this Agreement and the property must remain an approved Section 8 property for a period of two (2) years after the date of the completion of the MORE 2 program work. [12] If this Agreement is not adhered to in its entirety by the Owner, the cost of the MORE 2 program improvements shall be reimbursed by the Owner to the City. Failure to reimburse the City within 30 days of being notified of violation of this Agreement could result in the City taking action against the Owner to the fullest extent allowed by law. The Owner, Owner s Agent and dwelling occupant shall cooperate with Tennessee Valley Authority (TVA), the City of Oak Ridge, and/or their authorized representative(s) in performing evaluation, measurement, and verification (EM&V) of the MORE 2 project improvements at the subject property. Information collected and accessed as part of EM&V activities will include, but may not be limited to, electricity metering data, onsite verification of installations and program compliance, project records, and project site billing records. All information collected as part of EM&V activities will be held confidentially and will be used solely by TVA or its authorized representative only for MORE 2 Program analysis purposes. The Owner, Owner s Agent and Occupant shall ensure that TVA or its authorized agents have access to the project site at reasonable times, for a period of five (5) years from the date of the MORE 2 project s completion. Signature (Owner): Date: Signature (Witness): Date: Note: If the Authorized Agent signing this agreement is not the Owner of the subject property, the Authorized Agent must provide an original notarized affidavit signed by the Owner granting authorization to the Authorized Agent to sign this agreement for the Owner prior to signing.

6 APPLICATION FOR PARTICIPATION SUPPLEMENTAL INFORMATION PAGE Name (First and Last) Date of Birth Social Security Number Gross Monthly Income (List the amount and source of each income type) Notes: