LOW INCOME HOME ENERGY ASSISTACNCE PROGRAM (LIHEAP) Wood Vendor / Energy Supplier Agreement Letter

LOW INCOME HOME ENERGY ASSISTACNCE PROGRAM (LIHEAP) Wood Vendor / Energy Supplier Agreement Letter
All Wood Vendors must agree to the following written requirements:

- Any Wood Vendor or Energy Supplier receiving payment from the Yurok Tribe agrees not to discriminate, either in the cost of wood or the services provided against the eligible household on whose behalf the wood is supplied.

- Wood being supplied is obtained legally and if requested, verification must be provided.

- Copy current Driver’s License will be provided.

- Completed W-9 form will be provided.

- Each wood allocation must be ½ seasoned. The amount of wood per eligible household will be one cord.

- Wood for Elders or Disabled adults will be chopped to 6” in diameter and stacked. If you cannot stack the wood yourself, you must have an abled bodied person with you to do so.

- All names and household information given to Wood Vendors must remain confidential. Any violation in this regard will result in immediate termination of the current Wood Vendor / Energy Supplier Contract.

- Delivery must be completed within 10 days of receipt/notificaiton.

- Completed wood receipts returned within 3 business days (faxed or post marked) from date of delivery.
By signing below, I verify that I understand and agree to the requirements listed above.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

I (company or private party), NAME BELOW , have read and fully understand terms and conditions stated in the Yurok Tribe LIHEAP Agreement Letter. I agree to comply all terms and conditions stated in the Agreement Letter.
Printed Name
Signature
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Service Area

I, NAME BELOW , have read the Wood Vendor / Energy Supplier Agreement Letter and Vendor Agreement and will comply with the Yurok Tribe LIHEAP Policies in order to be a Wood Vendor / Energy Supplier in the area of Humboldt / Del Norte County.

I understand that I will be paid $400.00 per cord of wood delivered within my service area and $450.00 per cord of wood delivered outside of my service area. Service Areas are defined as: North, South, and East.

I have been informed that no other member of my household will be eligible to receive assistance from Yurok Tribe LIHEAP as I am being paid for my services as a Wood Vendor / Energy Supplier from the Yurok Tribe LIHEAP.
NAME

Please list all members of your household:

I understand that if it is discovered that a member of my household has received services from Yurok Tribe LIHEAP, I will have broken my contract and will no longer be paid as a Wood Vendor / Energy Supplier by Yurok Tribe LIHEAP.
Signature
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number
Filled W9

Cancelof
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