CHT Stewardship Form
Homeowner:
First Name
(Nombre)
Last Name
Email
Phone
Property address:
Address Line 1
Address Line 2
City
Eligibility
My initials below affirm that my CHT home is my primary residence. I have not sublet my home and I am not living elsewhere. I am in compliance with my Ground Lease.
(Please Initial)
My initials below affirm that I am current on my Stewardship payments and HOA dues (if applicable). I am not behind on my payments and I do not owe a balance to CHT or my HOA.
(Please Initial)
If you cannot affirm either question or you are not sure about your situation, or you are experiencing a financial hardship, Stewardship may still be an option. Please contact CHT for more info.
System to be repaired or replaced
:
Roof
HVAC
Water heater
Exterior paint
Floor coverings
Exterior siding
Laundry Machines (Greenbridge Only)
Other
(
Otro
)
:
Date existing system installed:
Reason for requesting Stewardship funds:
For roofs less than 15 years old, HVAC equipment that is less than 10-years old, water heaters less than 8-years old, and roofs less than 15 years old, you must obtain an estimate for repair from a contractor on the CHT Approved Vendor list.
-If your HVAC equipment is >10-years old, it is recommended that you also obtain an estimate for system replacement. Contractors typically do this for free, but it is your responsibility to confirm.
-CHT Stewardship funding can be requested for base-model HVAC equipment similar to what is present and meets minimum building code standards. No preference is given to specific manufacturers or brands. Warranty benefits may or may not be considered.
-Stewardship cannot be approved for equipment upgrades, for ductwork replacement, or for ductwork cleaning.
-If your equipment is >10-years old, it is recommended that you also obtain an estimate for system replacement. Contractors typically do this for free, but it is your responsibility to confirm.
-CHT Stewardship funding can be requested for base-model HVAC equipment similar to what is present and meets minimum building code standards. No preference is given to specific manufacturers or brands. Warranty benefits may or may not be considered.
-Stewardship cannot be approved for equipment upgrades, for ductwork replacement, or for ductwork cleaning.
(please initial below)
HVAC:
The towns of Chapel Hill and Carrboro require contractors obtain mechanical/electrical permits for HVAC replacements. Typically newly installed equipment must also be inspected, which requires an additional inspection after the installation is complete.
My initials below are my confirmation that I will make arrangements for someone to be home for any municipal inspections. I am responsible for any missed inspections or expired permits, and any fees that may be imposed by the Town of Chapel Hill or Carrboro.
Are you on an preventative maintenance agreement with an HVAC contractor?
No
Yes
If yes, when was the most recent date of PM service?
I understand that completing this form is not a guarantee that funding is approved. Any agreement or contract between a homeowner and contractor is a homeowner responsibility unless and until CHT has confirmed Stewardship funding can be approved and the contractor can invoice CHT directly.
Please initial below:
Flooring (Suelos)
If replacing flooring, in what room(s) will the work take place
Kitchen
Dining room
Living room
Full bathroom 1
Full bathroom 2
Half bathroom
Bedroom 1
Bedroom 2
Bedroom 3
Stairs
Other (hallways & closets)
Enter additional notes (Introduzca notas adicionales):
If replacing flooring, what type of floor covering will be installed (Si reemplaza el piso, ¿qué tipo de revestimiento de piso se instalará)?
Carpet
Tile
LVP (luxury vinyl plank)
LVP
Laminate
Hardwood
Other
Total Estimated Cost:
CHT Approved Contractor OR Other Option
(Contratista aprobado por CHT U otra opción)
I chose to
:
hire a CHT Approved Contractor
employ a contractor who is not CHT Approved
do the work myself (flooring only, requires pre-approval)
(hacer el trabajo yo mismo (solo pisos, requiere aprobación previa)
I choose to hire a CHT Approved Contractor to perform the work.
By checking the box and signing below, I agree to allow CHT to employ a contractor, direct, inspect, and approve the work; and disburse stewardship funds directly to the contractor. I will provide access to my home during all standard working hours. If the full cost of the work is not covered, I agree to pay the difference prior to the start of work.
I acknowledge
I choose to employ a contractor who is not CHT Approved.
I will submit my contractor’s proposal or
estimate or my own detailed scope of work and material data sheets. By signing below, I agree to the following conditions:
1
. I or my contractor must acquire all required permits and close them out promptly
(including safety requirements).
2. I will allow CHT to review and
when work is complete. The work must
meet all applicable codes
modify, if necessary, the scope of work, including specifications, inspection requirements,
etc., prior to beginning work.
3. I will allow CHT to inspect the work, both while in progress and when it is complete. I will promptly correct any
deficiencies CHT identifies. My contractor and I will accommodate in-progress inspections at CHT’s convenience.
4. I acknowledge the risk that CHT may, at any time, reject the work and decline to disburse stewardship funds.
5. I agree that I am solely responsible for full payment for all labor and materials. I will provide evidence that I
have paid in full for all labor and materials before CHT will release funds.
I choose to employ a contractor who is not CHT Approved.
Elijo
contratar
a un
contratista
que no
esté
aprobado
por
CHT.)
Contractor Info
Contractor name:
Contractor Phone Number
:
Contractor Email
:
CHT assesses applications for stewardship funding based on the criteria on page 5 of the
Community Home Trust’s Stewardship Program:
Contacts, Frequently Asked Questions, Application, and Guidelines
Updated July 1st, 2019
There is no guarantee you will be reimbursed in full or part if repairs/replacements are done outside of the scope of these guidelines.
The Stewardship Program is not a home warranty or an insurance product.
Electronic signature:
By entering my name here, I certify that all information entered above is factual and complete, to my knowledge
.
Contact Information