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Energy Information Release

Thank you for your interest in the District’s Residential Conservation Programs. If you decide to participate in this program, it will be necessary for you to provide some information which may be used to assist in the development of new programs and assess actual energy savings obtained. The information may be released to the public, but only in anonymous, statistical form.

Release of Present and Future Claims

In consideration of receiving the benefits and payments under the Residential Conservation Program, I agree that I will not make any claim or demand against the Public Utility District No. 1 of Lewis County and hereby release and discharge the District from any and all claims, demands, liabilities, suits, or causes of action, for any damage, injury or death allegedly arising, resulting or which may in the future result, directly or indirectly, from the measure(s) installed under the Residential Conservation Program. All program measures must be completed to meet state and local codes, it is the responsibility of the homeowner and chosen contractor to secure all necessary and required permits.

Program Participation

Participation in any District incentive, rebate, program, or conservation measure is subject to any and all associated program and funding requirements. These requirements may be included but not limited to the underlying funding source obligations such as grant requirements, federal funding requirements, state funding requirements, District funding requirements, etc.

Waiver

The customer agrees that Public Utility District No. 1 of Lewis County has no responsibility for production of energy savings estimated to result from this program. The customer agrees not to hold the District responsible for any direct or consequential damages which arise out of, or in connection with, the lack of production of energy savings.

Rebate Designation

I authorize Lewis County PUD to forward my incentive payment to: Once all information is collected, verified, and approved, the incentive will be processed and sent to the party selected above. One reimbursement per residence is allowed. Please allow six to eight weeks for delivery.

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Thank you for your interest in the District’s Residential Conservation Programs. If you decide to participate in this program, it will be necessary for you to provide some information which may be used to assist in the development of new programs and assess actual energy savings obtained. The information may be released to the public, but only in anonymous, statistical form.
In consideration of receiving the benefits and payments under the Residential Conservation Program, I agree that I will not make any claim or demand against the Public Utility District No. 1 of Lewis County and hereby release and discharge the District from any and all claims, demands, liabilities, suits, or causes of action, for any damage, injury or death allegedly arising, resulting or which may in the future result, directly or indirectly, from the measure(s) installed under the Residential Conservation Program. All program measures must be completed to meet state and local codes, it is the responsibility of the homeowner and chosen contractor to secure all necessary and required permits.
Participation in any District incentive, rebate, program, or conservation measure is subject to any and all associated program and funding requirements. These requirements may be included but not limited to the underlying funding source obligations such as grant requirements, federal funding requirements, state funding requirements, District funding requirements, etc.
The customer agrees that Public Utility District No. 1 of Lewis County has no responsibility for production of energy savings estimated to result from this program. The customer agrees not to hold the District responsible for any direct or consequential damages which arise out of, or in connection with, the lack of production of energy savings.
Once all information is collected, verified, and approved, the incentive will be processed and sent to the party selected above. One reimbursement per residence is allowed. Please allow six to eight weeks for delivery.
I hereby verify the information provided on this form to be true and complete. I understand that by typing my full name below and submitting this information, this form will be stamped with today’s date and authorized by me as if I had signed my signature. I certify under penalty of perjury of the state of Washington that I am the individual named in the electronic signature block.
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