Indemnification, Waiver and Release by xov14698


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									                                   Refusal of Ventilation:
                  Release of Liability, Indemnification & Waiver of Claims

Owner:                                      Occupant:

               <Weatherization Agency>               has inspected the dwelling unit you (the
owner) own at the address listed above and has determined that it needs mechanical ventilation
to supply an adequate amount of fresh air to the occupants of the dwelling. This determination is
derived from American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc.’s
62.2-2004 Standard: Ventilation and Acceptable Indoor Air Quality in Low-Rise Residential
Buildings, which utilizes the size and air tightness of the building and the number of current
occupants to determine the building’s ventilation requirements.
In addition to providing fresh air, ventilation removes air pollutants and excess moisture from
buildings. It is it important to have some mechanism to remove excess moisture generated by
the occupants. A bath or shower adds moisture to the air and over time that moisture may
damage parts of your building. We recommend operating a bath exhaust fan during and from 15
to 20 minutes after each shower or bath.

Despite our recommendations you have opted to decline the installation of mechanical
ventilation in your building. As we have determined a need for mechanical ventilation, we
require a release of liability from you prior to proceeding with any other planned weatherization

Release, Indemnification and Waiver of Claims: I acknowledge by my signature below
receipt of the information and recommendations for ventilation. Additionally, I agree to hold the
agency and its agents and the State of Wisconsin harmless for any moisture or indoor air quality
problems that may occur, develop, or worsen after the completion of the weatherization work,
and to fully indemnify the same from any and all third-party claims related to your refusal of the
installation of mechanical ventilation. This includes claims for building damage or medical
problems, including money lost by not being able to work, healthcare costs and pain or

I have carefully read this Release, Indemnification and Waiver and fully understand its
contents. I am aware that this is a release of liability and I have signed it of my own free

           Building Owner              Date            Agency Representative           Date

Home Energy Plus
Draft 4: 11/14/2006

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