HVAC Tune-Up Application/Checklist

Customer Information (must be completed) Customer Name: _________________________________ Address: ________________________________________ City, State, Zip: __________________________________ Phone Number: __________________________________ Service Account Number: __________________________ Service Date: ____________________________________ Contractor Information (must be completed) Company: ______________________________________ Service Technician (full name): _______________________ Phone Number: _________________________________ Address: _______________________________________ City, State, Zip: _________________________________ C-20 License Number: ____________________________

TO BE COMPLETED BY A SERVICE TECHNICIAN
Unit Information (include additional form if more than one unit is serviced) Model: _______________ Size (Tons): _______________ Age (if known): ________ Serial Number: __________ Systems Checklist required for Tune-Up and Refrigerant Charge Clean or replace air filters: Y N N N Clean, inspect & lubricate condenser coil fan motor: Y N N

Clean & inspect condenser coil: Y Clean & inspect condensate drain: Y Check thermostat operation: Y N

Clean, inspect & lubricate evaporator coil blower motor: Y Clean & inspect evaporator coil (if accessible): Y N

Inspect electrical wiring & tighten terminals/connectors: Y Inspect refrigerant piping for damage or leaks: Y N/A N

N

Inspect for proper fuse size & type: Amps: ____ Inspect, clean & straighten any bent fans: Y N

Check unit input voltage and current: Nameplate Volts: _____ Actual Volts: _____ Check unit refrigeration pressures, temperatures and refrigerant charge: Y N N

Conducted Refrigerant Charge according to original equipment manufacturer: Y

MUST INCLUDE COPY OF CONTRACTOR’S INVOICE Signatures Technician Signature (Required): ________________________________________ Date: _______________ I have read and agree to the terms and conditions of this program: Customer Signature (Required): _________________________________________ Date: _______________

Updated 06/14/2012

HVAC TUNE-UP PROGRAM TERMS & CONDITIONS • • • • • • • • • • Subject to fund availability and may be cancelled, modified or reduced at any time. Customers must fulfill all program-specific and general guidelines to be eligible for incentives. Rebate will not exceed 100% of total service receipt. Rebate must be submitted within 60 days of service. A copy of dated receipt must be provided, and is subject to verification. Application and Checklist must be provided. Incentive will be paid to the electric customer of record only. Customer is responsible for complying with local ordinances, restrictions, rules and regulations prior to installing any new equipment. Rancho Cucamonga Municipal Utility reserves the right to determine product eligibility. RCMU does not endorse or recommend specific brands, products, contractors or dealers, nor does it guarantee material or workmanship; acceptance of such is customer’s responsibility. If it is determined through inspection that the customer is not in compliance with the requirements of the program, RCMU may recover the total amount of the incentive or rate reduction paid to the customer for non-compliance. RCMU will issue customer a rebate of $30 per unit annually.

Updated 08/06/2012

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