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Attachment List

Low Income Eligibility Certificate Customer Agreement Form
Instructions for customer agreement form online signing:
Click the document name to open the online e-sign form and fill the form, complete the signature & click "Attach as pdf" and to correct the data in the saved attachment,delete the saved pdf file and repeat the above steps
NO RECORDS FOUND.

Customer Agreement and Certificate

Energy Efficiency Service Provider
Company Name :
Company Contact Name :
Address :
City, State, Zip Code :
Phone Number :
Email :
Customer information :

Energy Efficiency Service Provider ("EESP") is participating in one of the following Standard Offer Programs ("SOP") developed by Oncor Electric Delivery Company LLC (“Oncor”):

Check One :

Oncor ESIID number:

EESP and Customer agree as follows:

1. EESP agrees to install and Customer agrees to the installation of energy efficiency improvements that will produce energy savings and/or peak demand savings that are qualified for the SOP.

2. EESP warrants that it will install all energy efficiency improvements in a good and workman-like manner consistent with the prevailing standards for energy efficiency improvement installation as practiced by qualified contractors in the area and inform Customer of any adverse environmental or health effects associated with the improvements installed.

3. Customer shall have the right to cancel this Agreement at any time and for any reason prior to midnight of the third business day following the date of this Agreement. Customer may exercise this right of cancellation by providing EESP any written statement that is signed and dated by Customer and states Customer’s intention to cancel this Agreement.

4. Customer acknowledges that EESP is receiving an incentive for the energy and peak demand savings derived from Customer’s energy efficiency improvements and that such incentive is paid for through a ratepayer funded program, manufacturers or other entities.

5. Customer has received a written and oral disclosure of the financial arrangement between EESP and Customer. This includes an explanation of the total Customer payments, the total expected interest charged, all possible penalties for non-payment, and whether Customer’s installment sales agreement may be sold.

6. Customer acknowledges that any review, inspection, or acceptance by Oncor of Customer’s premises or of the design, construction, installation, operation or maintenance of the energy efficiency equipment is solely for the information of Oncor. In performing any such inspection or review or in accepting the installed equipment, Oncor makes no representation or warranty whatsoever as to the economic or technical feasibility, capability, safety or reliability of the equipment, its installation by EESP or its compatibility with Customer’s facilities. In addition, Customer acknowledges that Oncor makes no warranty or representation regarding the qualifications of EESP, and that the Customer is solely responsible for the selection of EESP.

7. The EESP must measure and/or report to the utility the respective energy and peak demand savings from the installed energy efficiency improvements.

8. EESP will maintain, or will ensure subcontractor maintains, liability insurance to cover property damage.

9. Customer acknowledges that EESP is an independent contractor and is not part of, nor endorsed by the PUCT or by Oncor, and that EESP is not authorized to make representations or incur obligations on behalf of Oncor. Customer further acknowledges that Oncor is not a party to Customer Agreement and that EESP and Customer are solely responsible for performance hereunder.

10. In the event of non-performance by EESP or the subcontractor, Customer may make a complaint to the Office of Customer Protection of the Public Utility Commission of Texas (PUCT) at 1-888-782-8477 or by email at customer@puc.texas.gov (TTY 1-800-735-2988), or the Office of the Attorney General’s Consumer Protection Hotline at 1-800-621-0508.

11. Customer has received a written disclosure of all warranties, work activities and terms and conditions.

12. No EESP, manufacturer, or other business involved in providing your energy efficiency improvements may ask or require you, the Customer, to give up your rights under consumer protection statutes, waive performance warranties, or make false claims of energy savings and reductions in energy costs.

13. Customer agrees to provide Oncor with access to Customer’s utility bills, project documentation, contractor invoices, and technical and cost information directly related to the project. In addition, customer acknowledges that consumption data may be disclosed to the statewide Evaluation, Measurement and Verification (“EM&V”) contractor for evaluation purposes.

14. Customer acknowledges Oncor will play no role in resolving any disputes that arise between Customer and EESP; however, Customer may register a complaint against EESP on the program website, https://www.takealoadofftexas.com/en/pages/contactus.aspx

15. If a subcontractor is used, EESP shall provide Customer an “All Bills Paid” affidavit guaranteeing that no mechanic's or materialmen's liens will be placed on Customer’s property relating to the installation of energy efficiency measures pursuant to this Agreement. If a subcontractor is used, subcontractor must sign where indicated below.

16. EESP will provide a complaint procedure for Customer to address performance issues by the EESP or subcontractor.

17. Customer agrees, upon three (3) days’ prior oral notice, to provide Oncor and the EM&V contractor selected by the PUCT with full and complete access to Customer’s property for any purpose related to the SOP. The right of access will be subject to Customer's reasonable access requirements and, unless otherwise agreed, must occur within normal business hours.

Indemnification: in consideration of the services provided, customer agrees to indemnify, defend and hold harmless Oncor from any claim or suit for damages of any kind to customer, or any guest, agent, contractor, or any affiliate of customer, arising out of or related to the project, for any cause of action even to the extent such claim or suit is caused by the sole or concurrent negligence or fault of Oncor.

Limitation of liability: with the exception of the indemnification provision above, to the extent that Oncor may be found liable for any damages arising from or related to this agreement, damages of any sort, including consequential damages, shall be limited to the amount of paid by the customer pursuant to the agreement.

Customer Signature
Sign Below
Energy Efficiency Service Provider Signature
Sign Below

Public Utility Commission of Texas Self-Certification

Form of Income Eligibility for Full Incentive Energy Efficiency Services

This statement is made to verify my household income eligibility. The Public Utility Commission of Texas has authorized energy efficiency programs to reduce the utility bills of income-eligible households. Contractors participating in the programs receive higher incentive payments when you are income-eligible. The purpose of the higher payment is to enable the contractor to provide the improvements at a very low cost or no cost to you. Participating in this program will not affect your eligibility for other program benefits listed below.


The information provided below will be used solely for the purpose of determining household eligibility and will be kept confidential by the investor-owned utility contractor or other representative and by the Public Utility Commission of Texas and their contractor. It will not be sold or provided to any other party.

Customer Information :
Category 1A:Eligible through other programs or services
At least one member of my household receive benefits from one or more of the programs listed below ( check all that applies, digital or paper copy of proof of participation such as award letter required with this form):
Bureau of Indian Affairs (BIA) General Assistance
Supplemental Nutrition Assistance Program (SNAP)(Food Stamps)
Federal Public Housing Assistance (FPHA)
Supplemental Security Income (SSI)
Food Distribution Program on Indian Reservations (FDPIR)
Temporary Assistance for Needy Families (TANF)
Health Benefit Coverage under Child Health Plan (CHIP)
Texas Lifeline Discount
Low-Income Energy Assistance Program (LIHEAP) or Comprehensive Energy Assistance Program (CEAP)
Tribal Head Start (only households that meet the income-qualifying standard)
Medicaid (includes CHIP)
Tribal Temporary Assistance for Needy Families (Tribal TANF)
Medicare, Qualified Beneficiary
Veterans Pension Benefit or Survivors Pension Benefit
National School Lunch Program-Free Lunch Program
Veterans Pension or Survivors Benefit Programs
Section 8 Housing Voucher

Your signature is required on the last page of this form.

Category 1B:Eligible through community action or social service agency
(COMPLETED BY UTILITY, COMMUNITY ACTION, OR SOCIAL SERVICE AGENCY)

I certify the named household participates in one of the programs in Category 1A or other low-income program service for which our agency qualifies participation.

Category 1C:Eligible through geographic location
(COMPLETED BY UTILITY OR THEIR REPRESENTATIVE OR PROVIDEIR)
( check box if applicable)
Housing and Urban Development (HUD) Low-Income Housing-Qualified Census Tract or Block
Category 2:Eligible through income verification
(DO NOT COMPLETE IF 1A, 1B, OR 1C COMPLETED ABOVE)

To accurately determine your household income, you must include the income of all persons residing in your home from all sources. To determine the amount of income in each category, enter the amount(s) on the check or benefit statement. Supporting documentation must be provided (all personal identifying information may be redacted except name and address).

Step 1. Fill out the Income Calculation table below.

Amounts listed are shown ( check one):

Income Calculation Table

Wages from full or part-time employment as shown on a paystub or W-2 form

Unemployment or worker’s compensation

Social security

Retirement income

Child support or alimony

All other earnings

TOTAL HOUSEHOLD INCOME

(Add the amount entered on each line to figure your total household income)

Step 2.Compare your total household income per week, month or year to the amount shown in the table below for the number of persons in your household. If your total household income is equal to or less than the amount shown in the table you are income-eligible.

200 Percent of Health and Human Services (HHS) Poverty Guidelines

Size of family unit Annual Income Monthly Income Weekly Income
1 $ 25,520 $ 2,127 $ 491
2 $ 34,840 $ 2,873 $ 663
3 $ 43,440 $ 3,620 $ 835
4 $ 52,400 $ 4,367 $ 1,008
5 $ 61,360 $ 5,113 $ 1,180
6 $ 70,320 $ 5,860 $ 1,352
7 $ 79,280 $ 6,607 $ 1,525
8 $ 88,240 $ 7,353 $ 1,697
Each additional person, add: $ 8,960 $ 747 $ 172
* Notice : Income ceilings are for February 1, 2022-January 31, 2023. Annual updates are posted on https://www.puc.texas.gov/industry/electric/forms/

(Electronic) By typing my name below, I certify the above statements to be true and correct to the best of my knowledge, and that this information can be used for the purpose of processing my Single-Family Income Eligibility for Full-Incentive Energy Efficiency Services Form.

(Non-Electronic) If filling out the delineation by hand, please provide your original signature and date.

I understand that the information is subject to audit and investigation by the investor-owned utility or representative providing the program services.
Applicant Signature
Sign Below
Contractor Signature
Sign Below
Keep a copy of this form for your records.
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Attachments

REQUEST FOR DUPLICATES APPROVAL

AHRI Data Mismatch
There is a mismatch between system found value from AHRI document and AHRI lookup value from EEPM database. Choose the correct one from the below list to use for EEPM calculation.
Choose AHRI Details From SEER2 EER2 (Btu/h)2 HSPF2
System found value from document
AHRI lookup value
AHRI Data Mismatch
There is a mismatch between system found value from AHRI document and AHRI lookup value from EEPM database. Choose the correct one from the below list to use for EEPM calculation.
Choose AHRI Details From SEER2 EER2 (Btu/h)2
System found value from document
AHRI lookup value
Name Plate Label Data Mismatch
Important Note :
   After Entering the AHRI number and the unit data is auto populate from the AHRI database, you must enter the missing characters as displayed on the condenser label photo. The Condenser model and serial reported within EEPM must match the label.
Example:
Picture 1: Before Correction.
Picture 2: After Correction.

In the above example, picture 1 has incomplete "User entered/AHRI populated" value, in this case copy and paste the value from 1st text field to second text field as per picture 2. In case both text fields are populates wrong value, manually correct the value as per label in the second text field and check the verify next to the field to complete this popup.
Field Name Value found from label User entered or AHRI value Is Value Matched? Verify & Update
New Unit Condenser Model #
New Unit Condenser Serial #
File Upload
File Upload
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