PLEASE READ THIS SECTION CAREFULLY:
My signature below authorizes weatherization Staff, Contractors and Crew to enter my home as needed and scheduled to perform weatherization and furnace work.
My signature verifies this residence is not currently for sale, nor is it designated for acquisition or clearance(foreclosure) by federal, state or local programs. Additionally, I understand that weatherization work cannot be done if the home is vacant or being renovated in any way that would affect the weatherization process. I intend to continue living in this home for at least twelve (12) months after weatherization services are completed.
Upon completion of work, I give permission for the contractor, sub-contractor staff, local, state, and federal officials toinspect said work. I understand final inspections are necessary and I will be responsible for payment of services if I refuse final inspections.
I understand the Weatherization Assistance Program (WAP) regulations prohibit warranties as an allowable program expense. Materials and labor being covered by manufacturers' warranties are for one year.
My signature below authorizes the Weatherization Assistance Program (WAP) and its designees to inspect heating, fuel usage and utility billing records for up to 5 years before and after completion of weatherization work and authorize pertinent utility and fuel companies to make such records available to them solely for obtaining data for evaluation of subsequent energy conservation effectiveness.
I agree, on behalf and for all who stand in my stead, that the state of Nebraska, its sub grantees and weatherization crews will not be held liable for any injury or expense incurred by me while participating in this program.
I attest to the best of my knowledge that the information on this form is correct and complete. This service is free of charge but if my home is served due to incomplete or incorrect information that would otherwise make my household ineligible, I accept responsibility for paying for services received.
I authorize the release of income and benefits information to the Habitat for Humanity of Omaha Weatherization Program to document my eligibility.
Pursuant to 5 U.S.C. 552(b)(6), of the Freedom of Information Act, Habitat Omaha’s Weatherization Program is required to keep confidential any specifically identifying information related to an individual’s eligibility application for weatherization services, or the individual’s participation in weatherization services, such as name, address, or income information. The State of Nebraska in conjunction with Habitat Omaha’s Weatherization Program may, however, release information about recipients in the aggregate in a manner which does not identify specific individuals