Low Income Heat Pump Application

For Ductless Heat Pump (DHP) and Ducted Mini-Split

All sections must be filled out by the installer at the time of installation. A copy of this completed form, the purchase receipt or invoice, and the manufacturer's Installation Checklist must be promptly submitted to the homeowner's utility in accordance with utility policy.

Eligibility Guide for DHPs and Ducted Mini-Splits: Ducted Mini-Splits do not include homes with whole house centrally ducted systems. See PTCS Air Source Heat Pumps for further information on whole home centrally ducted systems.

Terms and Conditions

OFFICIAL FORM: This form and any required additional documentation, including installation invoice, must be filled out completely, truthfully, and accurately. Project details, including incentives, are subject to change without notice.
CONTRACTOR'S RESPONSIBILITY: It is the responsibility of the Contractor to fully fill out this form at the time of installation, and to ensure this form has been signed by both the contractor and homeowner.
HOMEOWNER ELIGIBILITY: To be eligible for incentive payment, the home must have electric heat as the primary heat source. Qualifying applications are Single Family Homes with zonal electric heat, Single Family Homes with electric forced air furnaces, and Manufactured Homes with electric forced air furnaces. A qualifying home cannot: (i) be under construction, (ii) have a fossil fuel central forced air or fossil fuel hydronic heating system, nor (iii) have a split-system heat pump.
SYSTEM ELIGIBILITY: To be eligible for incentive payment, ductless heat pumps installed must be: a split system heat pump employing an inverter-driven, variable speed compressor, a variable speed outdoor fan, and a multi-speed or variable speed indoor blower. Additionally, indoor units using any type of field installed duct system are NOT eligible.
CONTRACTOR ELIGIBILITY: Contractors must be licensed, bonded, and insured, have successfully completed manufacturer sponsored training for equipment being installed and have attended an orientation provided by the NW Ductless Heat Pump Project (the Project) available at www.goingductless.com/partners.
CONTRACTOR REMOVAL: Non-compliance with installation specifications and/or Quality Assurance Inspections may trigger a performance review of the installation contractor. This review will be conducted by the NW Ductless Heat Pump Project Quality Assurance team. The performance review may result in suspension or permanent removal from participation. Findings of the performance review will be communicated, in writing, to the installation contractor and participating utility along with terms of suspension or removal.
VERIFICATION AND INSPECTION: Participating homes are subject to random onsite inspections in order to verify that installations meet Manufacturer specifications and that the home meets eligibility guidelines. You may be contacted by phone or email to schedule an inspection. No warranty is implied by this inspection.
TAX LIABILITY: Neither the utility, BPA, nor the contractor is responsible for any tax liability, which may be imposed on the Participant as a result of payment of any incentives or as a result of obtaining financing.
ENDORSEMENT: The NW Ductless Heat Pump Project does not endorse any particular manufacturer, contractor, or product in promoting ductless heat pumps. The fact that the names of particular manufacturers, contractors, or products may appear on Project materials does not constitute an endorsement. Manufacturers, contractors, or products not mentioned are not implied to be unsuitable or defective in any way.
SAFETY AND BUILDING CODES: The Participant agrees to pursue compliance with federal, state, and local building and environmental codes for the installation of this product. The contractor certifies products have been installed consistent with manufacturer instructions.
PROPERTY RIGHTS: The Participant must have proper authority to install the ductless heat pump system on the designated property or has obtained any necessary consent from the landlord.
ACCESS AND EVALUATION: The Project and its representatives may request access to the property on which the ductless heat pump system was installed to review and evaluate the system during and after Project completion. The Participant agrees to provide reasonable access to the property for the purposes described herein. In addition, the project may contact the participant for survey participation and project feedback.
REFRIGERANT LINE PROTECTION: At the time of installation, contractor must protect all exterior, insulated refrigerant lines. Protection is either UV resistant tape wrapped around insulated refrigerant lines or rigid line hides installed over insulated refrigerant lines.

Notes
¹Zonal heating includes electric, non-ducted: ceiling cable, wall, baseboard, plug-in, and an electric boiler/water heater attached to a zoned hydronic floor heating system.
²List Discontinued models, for which AHRI # is not listed as "Discontinued." List new models that have been submitted for review and approval, for which an AHRI # is not available as "Pending."

By signing below, the contractor certifies that this invoice form and all accompanying documents are complete and accurate. The signature certifies that the contractor is licensed, bonded, insured, has been trained by the manufacturer of the installed product and has received project contractor orientation. By signing this, the contractor has read and understood the terms and conditions listed on this form and/or project information on the NW Ductless Heat Pump Project website (www.GoingDuctless.com).