SAINT PAUL HOME LOAN FUND



Saint Paul Energy Smart Homes

REFRIGERATOR REBATE PROGRAM

“Cool Cash for COLD Clunkers”

Pre-Application

PRE-APPLICATIONS MUST BE POSTMARKED NO LATER THAN JUNE 11, 2010

Mail to:

Energy Smart Homes – Refrigerator Rebates

1100 City Hall Annex

25 West Fourth Street

Saint Paul, MN 55102

(651-266-6568)

|The City of Saint Paul is offering a limited number of $200 refrigerator rebates for ENERGY STAR rated refrigerators which are purchased for placement in Saint Paul |

|apartments where tenants are paying electric bills. The $50,000 (250 $200 rebates) in the Refrigerator Rebate Program is made available through a grant from the American |

|Recovery and Reinvestment Act of 2009 (“ARRA”). Because funds are limited, pre-applicants will be entered into a pool, from which participants will be selected at random.|

|Those who are selected will be eligible to participate in the Refrigerator Rebate Program. |

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|Who’s Eligible to Participate in the random selection process? |

|Owners of apartment buildings located in Saint Paul which contain 4 or more rental units where tenants pay their own electric bills. The buildings must have A or B |

|classifications from the Department of Safety and Inspections. |

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|How will the random selection process work? |

|To be considered for participation, eligible owners must complete and sign this pre-application and return it to the address above. It must be postmarked on or before |

|June 11, 2010. |

|Each applicant is limited to one pre-application. Duplicate pre-applications will not be considered. |

|If you choose to supply all of the requested data, your completed rebate pre-application will be processed. If you refuse to supply data requested on the pre-application |

|form, your pre-application will not be processed. (Please note that rebates and rebate pre-applications may be considered public documents and may be subject to disclosure|

|to the public upon request.) |

|Participants will be selected at random on or about June 17, 2010, from the complete, signed, and on time pre-applications that have been received. Participants will be |

|notified by letter of their selection and the specifics of the program. The City will make every effort to notify pre-applicants whether the pre-application is approved |

|within 30 days of receipt. |

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|How will the program work? |

|Selected participants will have 60 days from notification to purchase specified ENERGY STAR rated refrigerators from City approved vendors and to apply for rebates. |

|Selected participants can purchase up to ten (10) ENERGY STAR rated refrigerators to replace working non ENERGY STAR rated refrigerators located in the apartments |

|identified on the pre-application. |

|Participants must submit to the City a copy of the paid invoice and the certificate from the approved appliance provider listing the make and model # of the new |

|refrigerator, make and model # of the working replaced refrigerator, and where the old refrigerator has been decommissioned. |

|Upon receipt of the required documentation, rebate checks will be sent to the program participants. |

|Participants must agree to random checks by the City to ascertain that the refrigerators remain in the rental units for which they were purchased for use by tenants. |

|IMPORTANT: Do not order, purchase or install any equipment before receiving a rebate confirmation letter indicating that the pre-application has been approved and you |

|have been selected for participation in the refrigerator rebate program. Failure to comply with any requirement at any point in the rebate process may disqualify the |

|applicant from receiving a rebate. |

|The City reserves the right to adjust the terms and conditions of the Program as necessary, or request additional information. |

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|Minnesota Data Privacy Act/Tennessen Notice |

|The Minnesota Data Privacy Act requires that certain information you provide on this form remain as private data. The information about you that is collected on the Energy|

|Smart Homes – Refrigerator Rebate Program application will be classified as either public or private data. Public data will be accessible to the public. Private data about|

|you will be accessible only to you and city personnel and their authorized subcontractors who administer the program and reporting requirements. The data you give us about|

|yourself is needed to: |

|Identify you; |

|Contact you in case of program or energy use evaluation; |

|Comply with certain federal and state reporting requirements; |

|Evaluate program effectiveness; and |

|Administer the Energy Smart Homes – Refrigerator Rebate Program. |

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|English: Attention. If you want help translating this information, call 651-266-6568 |

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|Espanol: Atención. Si desea recibir asistencia gratuita para traducir esta información, llame al 651-266-6568 |

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|Somali: Ogow. Haddii aad dooneyso in lagaa kaalmeeyo tarjamadda macluumaadkani oo lacag la’ aan wac 651-266-6568 |

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|Hmoob: Ceeb toom. Yog koj xav tau kev pab txhais cov xov no rau koj dawb, hu 651-266-6568 |

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|SECTION 1. PRE-APPLICANT(S) INFORMATION |

|Name:                           Business Name:                 |

|Mailing Address:                           City:                 |

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|State:                 Zip:                 |

|Email address: |

|Home Phone Number: (     )            Cell Phone Number: (      )            |

|SECTION 2. APARTMENT BUILDING INFORMATION |

|Do the apartment buildings have a current C of O? | Are the buildings Class A or B? Yes No |

|Yes No | |

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|SECTION 3. Addresses of Apartments Where Refrigerators Will be Installed |

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| |Address and Apartment # (s) of Apartment Building: |Total Number of Refrigerator rebates requested: |

|1. | | |

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|2. | | |

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|3. | | |

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|SECTION 4. SIGNATURES |

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|I certify that the statements contained in this pre-application are true, accurate and complete to the best of my knowledge and belief. |

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|Pre-Applicant:                 Date:       |

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