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02/02/2010 09:20 FAX 3869439434 f!001/002 <br /> InWeatherization .Assistance Programs <br /> (WAP, WAP- L.IHEAP & LEHRP) <br /> Form PwOA.os <br /> .Pre-Work Order Agreement <br /> Below is a list of the work to be completed on your home. These services are free and funded by the State of Florida <br /> and should make your home safer and more energy efficient However, these are not home repair or rehabilitation <br /> programs and are (limited in the scope of work that may be perfom ed. Please review the below list and sign to <br /> indicate your understanding of the work that will be performed on your home. <br /> SPECIFIC WORK TO BE COMPLETED: <br /> .. Nr) <br /> 1)- Install AC filters install-1 leave -1 (livingrm) <br /> 2) —Wrap water heater ( hall) lines W ' 3) — Insulate Oft hot & cold water es (hall) <br /> 4) — Replace 2- doors, doorknobs & deadbolts ( front & back ) <br /> 6)- Replace 8- windows (3 -NORTH 2-SOUTH 3-WEST Iivirgrm) <br /> 8)- Install 10 -CFL;s (4-bedrm 4- hvingrm 2- bathrm) 1/ <br /> 7)- Repair flex duct under home, <br /> 8)- Seal retum & supply vents with meastic <br /> 9)- Replace refrigerator (14 cu ft) no ice maker <br /> 19)-Replace heat pump (2 -TON ) <br /> 11)- Install 1- CO alarm & 2- smoke alarms <br /> 12)- Replace exhaust fan In kitchen <br /> 13)- Repair bathrm faucet <br /> I acknowledge that I have been informed that based upon the irnaI inspection process, my house appears to have less <br /> than two square feet of mold and/or mildew present and that these programs are limited In regard to addressing the <br /> source of water Intrusion that may be causing the mold. I further acknowledge that although the services to be <br /> performed may not totally eliminate the problem, they will not promote new growth, end that there are health risks <br /> associated with mold and mildew if not removed. Therefore, by signing this form, I understand that the Mid - Florida <br /> Community Services. Inc. is providing these services In good faith and shall be held harmless If new mold appears. <br /> I also acknowledge that 1 have received two pamphlets, 'Renovate Right important Lead Hazard Information for <br /> Pen:Mies, Ch/M Care Provides, and Schools" and "Mol4 Afoletru►e and Your Horne ", and a copy of the agency <br /> grievance procedures. <br /> �' ent Signature Date Agency Official Signature Date <br />