LOW INCOME PROGRAM

Weatherization Eligibility Requirements An energy audit must be performed prior to the installation of any low income measures to be eligible for rebates. Lewis County PUD provides energy audits at no charge to current customers.

Homes with the following heating systems are eligible for the weatherization portion of this program.

Permanently installed electric heating system Baseboard, Wall, Ceiling resistance heat Electric forced air furnace Electric fired boiler Heat pump

Some homes that utilize supplemental heating systems such as free standing stoves or fireplace inserts, may also be eligible provided these systems are accompanied by the current, and verified usage history of plug-in electric space heaters.

Homes with a forced air furnace or boiler fueled by natural gas, oil, or propane are not eligible for incentives. These customers should contact their gas or oil provider to inquire about available programs.

Ductless Heat Pump Eligibility Requirements

Electric or wood heating systems in site built and manufactured homes are eligible for this program. Homes with

supplementary gas stoves & fireplace inserts may also be eligible.

Homes with gas, oil, or propane forced air furnaces and boilers are not eligible for this program.

Income Requirements

Household gross earnings cannot exceed 200% of federal government poverty standard

Incentives

Insulation

*Site Built Homes Only

Attic

100% of installed cost

Floor

100% of installed cost

Wall

100% of installed cost

Windows

NFRC Rated U-Factor .30

Single Pane $15.00 / sq.ft.

Double Pane Metal $15.00 / sq.ft.

Patio Doors

NFRC Rated U-Factor .35

Single Pane $15.00 / sq.ft.

Double Pane Metal $15.00 / sq.ft.

Low Income Ductless Heat Pump

Installed Outdoor Unit Size

Incentive

12k – 15k $4,100

18k $4,300

24k $4,600

After the eligibility requirement has been met, the following steps are applicable:

1. After your initial audit is completed you will receive a list of eligible measures for your home.

2. Lewis County PUD offers a courtesy list of area contractors, available in our Chehalis and Morton offices as

well as our website www.lcpud.org. A regional list of approved heat pump contractors can also be found on

www.goingductless.com.

3. Approved low income customers must obtain a minimum of two bids and submit them to energy services

for review.

4. A verification of the measures installed may be conducted by a member of our Energy Services team to ensure the installed measure(s) meet program specifications.

5. Payment of the verified incentive is made to the chosen party.

Please note that if you choose to do weatherization work yourself or have an installer other than one on

our provided list do the work, you must complete and submit the weatherization homeowner acknowledgement form, and all receipts and/or paid invoices for verification. The incentive will be paid to the homeowner after a measure verification appointment has been completed.

We also offer a financing program for energy efficiency projects. Please refer to https://www.lcpud.org/save-energy/energy-efficiency-loans/ for more information. We look forward to your participation in the Low-Income Weatherization Program. If you have any questions, please contact us at your convenience. Energy Service Dept. PO Box 330 Chehalis WA 98532 Email: energyservices@lcpud.org Phone: (360) 748-9261 ext. 493 Toll free 1-800-562-5612 ext. 493

DEFINITION OF INCOME Refers to total annual cash receipts before taxes from all sources, with the exceptions noted below. Income

data for a part of a year may be annualized in order to determine eligibility--for example, by multiplying by four

the amount of income received during the most recent three months.

Income Includes

Money, wages and salaries before any deductions; net receipts from non-farm or farm self-employment

(receipts from a person's own business or from an owned or rented farm after deductions for business or farm

expenses).

Income Also Includes

Regular payments from social security, railroad retirement, unemployment compensation, strike benefits from

union funds, worker's compensation, veteran's payments, training stipends, alimony, and military family

allotments; private pensions, government employee pensions (including military retirement pay), and regular

insurance or annuity payments; dividends, interest, net rental income, net royalties, periodic receipts from

estates or trusts, and net gambling or lottery winnings.

Income Excludes

Capital gains; any assets drawn down as withdrawals from a bank, the sale of property, a house, or a car; one-

time payments from a welfare agency to a family or person who is in temporary financial difficulty; tax refunds,

gifts, loans, lump-sum inheritances, one-time insurance payments, or compensation for injury.

Income Also Excludes

Non-cash benefits, such as the employer-paid or union paid portion of health insurance or other employee

fringe benefits, food or housing received in lieu of wages, the value of food and fuel produced and consumed

on farms, the imputed value of rent from owner-occupied non-farm or farm housing, and such Federal non-

cash benefit programs as Medicare, Medicaid, Food Stamps, school lunches, housing assistance and combat

zone pay to the military.

Income Guidelines

Columns A and B show that maximum income allowed at 200% of the poverty guidelines. Further income documentation testing may be required to determine actual eligibility. All documentation must be legible.

Income levels shown below are based on Gross Income.

Required Documentation

INCOME ELIGIBILITY GUIDELINES

Household Size Monthly Income Annual Income

1 $2,126 $25,520 2 $2,873 $32,480 3 $3,616 $43,440 4 $4,366 $52,400 5 $5,113 $61,360 6 $5,860 $70,320 7 $6,606 $79,280 8 $7,353 $88,240

For each household member, provide copies of one of the following

For each household member with income, Provide the following documents that apply

Adults 18 years and older • State ID or driver’s license • US passport of passport card • Military ID or dependent ID card • Tribal membership card w/ picture • US visa or resident alien card • Foreign passport

Children under 18 years • State ID or driver’s license • Birth certificate • State medical card • Social Security card • US passport or passport card • Military dependent ID card • Tribal membership card w/ picture • US visa or resident alien card • School or daycare record • Pension

1. Pay stubs for the 3 complete consecutive months prior to the signature date on this form (for example, if signed in May, submit February, March, & April).

2. Current year Social Security, VA or Pension award letter.

3. Bank Statements for the same 3 month period explained above.

4. Investment dividend or disbursement statements

5. Last completed IRS tax return

6. Any other Income

HEAT PUMP INSTALLERS LIST

Public Utility District No. 1 of Lewis County has compiled this list as a convenience for its customers. The presence of an installer’s name on this list does not mean that the installer is financially or technically competent to perform work for you. Any contract between you and an installer, whether listed below or not, is at your own risk.

Business Name Phone

Chehalis Sheet Metal (360) 748-9221 Chehalis, WA PTCS, DHP

Americool Heating & Air (360) 273-3300 Rochester, WA PTCS, DHP

Renaud Electric (360) 423-1420 Kelso, WA PTCS, DHP

Carlson’s Heating & Air (360) 425-4888 Kelso, WA PTCS, DHP

Magruder Heating & Cooling (360) 208-3665 Pe Ell, WA PTCS, DHP

Advanced Energy Systems (360) 748-1817 Chehalis, WA DHP

Scott’s Heating (360) 978-4936 Ethel, WA DHP

Alpine Ductless (360) 529-7567 Olympia, WA DHP

Twin County Mechanical (360) 748-1888 Chehalis, WA DHP

Mills Heating & Cooling (360) 520-6284 Chehalis, WA DHP 4 Seasons Heating & Air Conditioning (360) 736-6288 Chehalis, WA DHP

Actionaire, Inc. (360) 538-0873 Hoquiam, WA DHP DHP = Ductless Heat Pump systems

Business Name Phone

Northwest Heating (360) 748-7961 Chehalis, WA PTCS, DHP

Sunset Air (360) 456-4956 Lacey, WA PTCS, DHP

Brennan Heating & Air (877) 273-6626 Seattle, WA PTCS, DHP

Denali Heating & Air (360) 274-8049 Castle Rock, WA PTCS, DHP

Twin City Service Co. (360) 425-3320 Kelso, WA PTCS, DHP

Rawhide Electric Services LLC (360) 577-3860 Longview, WA PTCS, DHP

Energy Star Systems & Stoves (360) 748-8808 Chehalis, WA DHP

Eastco Electric (360) 983-8313 Mossyrock, WA (360) 269-3824 DHP

Butch’s Heating & Air (360) 880-1040 Chehalis, WA DHP

CSI-HVAC (253) 224-8301 Tacoma, WA DHP Apple Electric (360) 295-3036 Vader, WA DHP PTCS = Ducted Forced Air Systems

WEATHERIZATION INSTALLERS LIST Public Utility District No. 1 of Lewis County (the District) has established a weatherization Installer’s list. The presence of an installer’s name on this list does not mean that the installer is financially or technically competent to perform work for you. Any contract between you and an installer listed below is at your own risk.

ADDRESS PHONE Carrig & Dancer Enterprises (253) 584-7704 Lakewood, WA 98499 (800) 547-5831 Insulation & Windows Eubanks Glass (360) 736-3314 Centralia, WA 98531 Windows INSULTECH (360) 496-6658 Morton, WA 98356 (360) 280-5525 Insulation The Roof Doctor, Inc. (360) 736-0246 Chehalis, WA 98532 Windows Echo Energy LLC (360) 515-0166 Lacey, WA 98513 Insulation

Evergreen Insulation (253) 985-5457 Olympia, WA 98502 Insulation Two Brother Insulating LLC (360) 773-0672 Woodland, WA 98674 Insulation

ADDRESS PHONE A Glass Enterprise (360) 736-1141 Centralia, WA 98531 (800) 223-1141 Windows Boulton Insulation (360) 330-0330 Olympia, WA 98421 (800) 422-7923 Insulation

Insul-Pros (360)388-2185 Centralia, WA 98531 Insulation

Vessey & Sons Construction (360) 878-6921 Oakville, WA 98568 Insulation & Windows Capitol Home Improvement (253) 847-6750 Spanaway, WA 98387 Windows CC Windows Solutions (253) 537-2290 Tacoma, WA 98445 Windows

Lewis County PUD Low-Income Program Application

Occupant Information Account Holder Name Account Number Service Address (Street, City, State, Zip)

Phone Number: Housing status: Own Rent Subsidized

Household Members list all people who permanently reside in the household, Identification for all people listed is also required.

Name(s)

Include first and last name of all household members, beginning with the primary applicant

Age Income Source

Verified with

(Code)

Total Income For Months

Total Gross

Deductions: 10% for Retirement (if taxed)

15% for Unemployment 20% for earned income

Month 1 Month 2 Month 3 Applied % Amount Adjusted

Gross

Income Documentation Used (Code)

A) Tax Return B) Bank Statement C) Pay Stub D) Social Security Award Letter E) No Income Statement F ) Other

Signature & Acknowledgement Calculations By signing below, I certify that the information I have provided with this application is complete and accurate to the best of my knowledge and belief. I understand that I am signing this form under penalty of criminal prosecution if I knowingly give false information which results in payment to which I am not eligible for, and I will be required to repay Lewis County PUD for any assistance received.

Primary Applicant Signature Date

Total Adjusted Gross Income

Number of Months Documented (3 months or 12 months)

Average Monthly Income

Staff Signature