AFFORDABLE ENERGY CORPORATION ASAP: The All Seasons Assurance Plan

SERVICE AGREEMENT

The Affordable Energy Corporation administers a utility assistance program called the All Seasons Assurance Plan (ASAP). ASAP will pay a portion of the head of household's utility bill to LG&E each month. The ASAP plan will assist eligible participants who agree to make regular monthly payments based on a "Modified Fixed Credit" plan which encourages energy conservation and allows participants to have an affordable monthly utility payment. Clients are required to recertify for the program each year through the LIHEAP Subsidy program administered by Community Action Agencies. Either party can terminate this agreement with a 30-day written notice.

I. Eligibility Requirements. I certify that I meet the following requirements: a. I am an LG&E customer and I am a full-time resident at the address listed on the

application. b. I am a homeowner or the lawful renter. I am the primary LG&E account holder

or it is in my spouse's name and I am listed as secondary on the account. c. My Monthly income meets the 130% of the federal poverty guidelines or less. d. I have a minimum of $100 monthly income. e. My utility arrearage (amount past due) is less than $1000. f. I do not receive Section 8 or any housing that is subsidized with a utility

allowance. g. I must apply for the LIHEAP Subsidy program every year and be eligible to be

considered for continued assistance from ASAP. h. I do not have a commercial account with LG&E. i. I commit that I do not use any high usage appliances, such as but not limited

to: a heated hot tub, a heated swimming pool or tanning bed. j. l do not operate a business in my home that requires high energy usage items.

II. Financial Agreement: LG&E Monthly Utility Bill. a. I understand that I must pay the portion of my bill in full and on time

each month to be eligible for ASAP payments. b. I understand that ASAP will pay a predetermined amount directly to LG&E

toward my monthly utility bill and that I am responsible for paying the remainder of the amount on my utility bill each month.

c. I understand the benefit sheet I received states the amount ASAP has agreed to pay on my utility bill.

d. I understand the ASAP payments are a grant and do not need to be repaid. I hereby designate ASAP to be given Third Party Notice of activity on my account.

e. I understand that if any other person is now receiving Third Party Notice, he/she will no longer receive such notice from LG&E.

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f. I understand that any credit balance on my LG&E bill as a result of the ASAP payments are the property of ASAP.

Ill. Head of Household Payment Procedures: I understand that as a participant I agree to the followin9.: 13 I am responsible for paying my portion of the monthly 1 itil1ty hi!I by the d11e date 14. If I do not pay my portion of the monthly utility bill ASAP will receive a Third-Party

Notice from LG&E stating I have not paid. ASAP will make no further payments until I have paid the total amount I owe for the month.

15. I understand if my utility bill is not paid by the due date, I am subject to LG&E's disconnect policy. If I am disconnected for non-payment, I will be responsible for paying all fees assessed from LG&E for reconnection.

16.lf I have not paid my monthly bill, I will receive a letter, and possibly a phone call, informing me that I have not paid my utility bill. I am responsible for paying my portion of the monthly utility bill in full within 15-20 days of the date of the letter. Case management services will be offered to suggest community resources that may be able to assist me with paying my portion of the bill.

17.lf 1 do not pay my monthly bill within those15-20 days, 1 will receive a Warning Notice stating that the monthly amount must be paid in full within 15-20 days after the date of the Warning Notice or I will be terminated from the program.

18.After I have paid my utility bill in full, ·if it is before the termination date, ASAP will pay the designated portion of the bill and will resume regular monthly payments.

19. If I still have not paid my monthly utility bill with in 15-20 days of the Warning Notice, I will receive a Termination Notice informing me that I have been terminated from the program.

20. If I am terminated from the program, or if I leave voluntarily, I will be solely responsible for the entire amount of all monthly bills then owed to LG&E or billed by LG&E after termination.

21. I understand that upon termination from the program, the entire amount I owe to LG&E is solely my responsibility.

22. I hereby authorize ASAP to release all information regarding my LG&E service, LIHEAP certification, and all other ASAP information to any other assistance agency which ASAP deems necessary, with the purpose of helping me pay my monthly bill to LG&E or any related purpose.

23.lf I am terminated from ASAP for any reason, I may only appeal my termination once and can only reapply for ASAP one year after my termination.

24. If I am terminated because of failing to pay a past due balance and am reinstated, my account must remain current for the rest of the year. I understand that I am not entitled to further warnings for past due balances, therefore if I fail to make a future payment by the due date, I will be terminated without notice.

IV. Weatherization and Energy Conservation Education. --------1 =u~naerstand that as a part1c1pant I agree to the following:

3. If services are offered, I agree to receive weatherization and/or energy conservation education. If I do not cooperate, I could be removed from the ASAP program.

4. I hereby authorize the All Seasons Assurance Plan (ASAP) to release all information regarding my LG&E service, LIHEAP certification, and any and all

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other ASAP information, to the provider of weatherization services to the extent the provider or providers determine is necessary in order to weatherize my home.

V. Status Change in which I must notify Affordable Energy Corporation (ASAP): I understand that as a participant I agree to the following: a. If I move to a new address or change my LG&E account number, I must notify

Affordable Energy Corporation within ten (10) days of ending the services on my current address. A change in my status may eliminate me from the program.

b. If I move to a new address or change my LG&E account number, the account MUST be in my name.

c. If I am no longer an LG&E customer, I must notify AEC within ten (10) days of the services ending.

d. In the event that the household separates, the assistance stays with the applicant. However, a new account must be established in the applicant's name in order to stay in the program.

e. In the event that the applicant passes away, the assistance may transfer to the next head of Household. This person must notify us within 45 days to establish a timeframe before the next recertification period, for which they must transfer the account into their name and provide the most recent LIHEAP application as verification of income and residency with the applicant.

f. If my LG&E account name changes, I must notify AEC within ten (10) days. g. If I move to a temporary residence or become homeless, I must notify AEC

within ten (10) days. I understand that ASAP will not make any payments during temporary residency. I understand I will have 60 days to secure permanent housing and LG&E service in order to continue to receive ASAP payments.

VI. If I declare bankruptcy, from which an outstanding balance with LG&E is included, I understand I may no longer qualify with ASAP. I must notify AEC within ten (10) days and I understand I must establish a new LG&E account to remain as an ASAP client. I understand within my first year of participation in ASAP, ASAP will no longer make the portion of the payment designated to help pay off any arrearage.

I understand that I may terminate my agreement with the All Seasons Assurance Plan (ASAP) at any time by providing written notice to the program. I also understand that the Termination Policy and the Client Complaint Procedures are a part of this agreement just as if they had been stated in full in this document. I acknowledge that I have understood and agreed to the above conditions and that I have received a copy of the Termination Policy and Client Complaint Procedures for the All Seasons Assurance Plan.

Print Name

Signature Date

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Please Print:

Name:

Address:

City:

Phone:

Email:

AFFORDABLE ENERGY CORPORATION ASAP: The All Seasons Assurance Plan

RELEASE OF INFORMATION AUTHORIZATION

Work:

AND WAIVER

I am the applicant? D Yes D No

Apt#

Zip Code:

Cell:

Primary Language: D English D Other:

LG&E Account Number:

LG&E Account Holder Namefs):

The person listed on the LG&E Account is: D Myself D Landlord-Property Owner D_R~lative D Other (please specify)

Does the account holder reside at the address of the applicant? DYes D No

In order to be eligible for the All Seasons Assurance Plan, I hereby release the following information to the Affordable Energy Corporation. I understand that by releasing said information, Affordable Energy Corporation may determine whether I would benefit from this program, the level of benefits for which 1 may be eligible, and to study the effectiveness of the overall program. I further acknowledge my understanding that by releasing said information, I am not assured of being selected or if already on the program, I am not assured continued enrollment as a participant in the program. By releasing said information, I am only being considered for enrollment in the program. By my signature below, I hereby authorize the Louisville Gas and Electric Company (LG&E), my Community Action Agency (Louisville and Jefferson County CAA; Tri-County CAA; Multi- Purpose CAA; Central Kentucky CAA, Community Action of Southern Kentucky, Lake Cumberland CAA), the MHNA/HFPP (Homeless Families Prevention Program), and federal housing subsidy providers to release to the Affordable Energy Corporation all records regarding my customer service account, including the following: payment records, usage data, EMPP estimates, meter reading dates, service disconnection and brown bill history data, arrearage, billing due dates and amounts, pledges and partial payments agreements for both gas and electric use, existing Third Party notification information, all intake and benefit information from the LIHEAP Subsidy program and LIHEAP information in future years that I remain on the ASAP program, and any information to determine whether or not I am receiving a utility allowance as part of a federal housing subsidy. I authorize release of said information for the past sixty (60) months and for the latter of sixty (60) months after the date of this release or six months after my participation in ASAP ends if I qualify and enroll in the program.

====-- 1. understand that I may withdraw my penpis.si.on to release the above-stated information at any time by making a written request to the Affordable Energy Corporation. I hereby release LG&E, CAA, AEC, HFPP, and federal housing subsidy providers from all liability whatsoever arising out of the release of this information and agree to hold said parties harmless from all claims that may arise out of this release.

Signature: Date:

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WELCOME TO ASAP ORIENTATION CLIENT DEMOGRAPHICS

Please Print:

Name: I am the applicant? D Yes D No

Address: Apt#

City: Zip Code:

Phone: Work: Cell:

Email :

ASAP Number: LGE Account Number:

Orientation Location: Benefit Amount:

ADDITIONAL INFORMATION REQUESTED:

Primary Language: D English 0 Other:

Are you a representative for an invited ASAP participant? Yes No

Representatives Name:----------------­

Phone: - ------

What is your Household Size: #Adults __ #_O_h_ild~r~e""--­

Are you age 60 years or older? Yes No

What is the income source(s) for you and everyone in your household (check all that apply): _paycheck _ social security _SSI Benefit _ Pension _ Disability _ Other

Do you rent or own your home? ( ircle one) Rent Own

What type of home do you live in? (Circle one) House Apartment Trailer

Do you receive a housing subsi y? (Circle one) No Section8 Income-based New Directions Other

Is English your second Language: Yes No

What is your first language: ______ _

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Enrollment ID#: IGf. WeCare Program Project Warm/ ASAP Collaboration

Weatherization Enrollment & EligibiHty Confirmation

.____ ____ __,

Veteran? a PPL company

PLEASE PRINT O Yes o No

APPLICANT DATA

LG&E Account Number (####-####-####) LG&E Account Holder:

Participant's Relation t o Account Holder: o Self D Other:

Participant's Name:

Address: Apt.:

City: State: ZIP:

Home Phone: - - -------Cell Phone: Work Phone:

Type of Residence: D Home O Mobile Home D Duplex{f riplex/Quad o Apartment 4+ Units

Date Moved into Residence· Email :

Check the box below if you are the Renter or Owner: If Renter, fill in LANDLORD INFORMATION

0 Renter (Landlord Consent Required) O Owner (Mobile Home Residence for this program if you own the trailer, check owner)

If Renter. Landlord's Name:

Address:

City: State: ZIP:

Home Phone: Work Phone:

INCOME QUALIFICATIONS

List people in household, including self:

First Name, last Name "'='"> '.§_ender Date of Birth Monthly Income ($) Source of Income Disabled? Yes/ No ]

Self:

I agree to the terms and conditions listed on the other side of this document, and flereby release LG&E, LG&E Business Partner, SEEL, Project WARM, ASAP and any other referral agency named above from any and all liability whatsoever arising out of the release of information as set forth herein, and agree to hold said parties harmless from all claims that may arise out of such release.

Participant's Signature: Date:

LG&E and KU use only

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Received Date: _ ____ ____ ________________ .-----------~

Reason if Ineligible: D ROSA/HEAP 3 yrs. D Usage: Move-in Date ___ _ _ _ _ o Scanned

o Received WeCare 3 yrs.: Complete Date _______ __ ___ D_a_te_s_c_a_n_ne_d _______ -- -- -- -- -___.

White: WeCare/ Project Warm Yellow: ASAP LIHEAP Qualified Rev. 01/2020

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Additional terms and conditions - Release of information and vvaiver

/11 order to be eligible for the LG8. E and KU WeCore Program, I hereby release the following information to the LG&E and KU

WeCare Program. I understand that by my releasing said information LG&E and KU WeCare Program may de termine whert1er

I wouid benefit from this propram and the level of benefits for which I am eligible. and study the effectn·eness cf the 011erol/

program. I further acknowledge my understanding thar by releasing smd information, I am not assu red of bemg selected- or if

aiready on the program. I am not assured continued enroilmem as o participant in th<' program. By releasing smd information

I am only being considered fo r enrollment in the program.

By my signature on the other side of this document, I hereby authorize the release tc the LG&E and KU WeCore Progrcm

referral agencies ( Project WA RM , ond any other refer rol agency named on the other side of this document) all records

regarding my utility customer service account for the past 12 months and for the next 16 months subsequent to the date of this

releose, including the following: payment records, usage data EMPP estimates. meter reading dates. service discorinection

and "brown bilr history daw, arrearoge, billing due dates and amounts and partial pay ment agreements fo r both gas and

electric use, existmg thlfd·porry norificotion information, and all intake and benefit information from rbe UHEAP subsidy

program.

I imderstand that I may withdrmt my permission tc release the above-s tateo informa tion at any time by making a written

reques1 to the LG&E and l<U WeCore Program.

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