HVAC Assessment Request Form
The Minnesota Coalition for the Homeless (MCH) is providing funding for assessments for heating, ventilation, and air conditioning (HVAC) system assessments at eligible sites around the state. This funding is part of a national effort to improve building ventilation for vulnerable Americans in light of the COVID-19 pandemic. Qualified organizations may receive a free assessment of the HVAC system in one eligible emergency shelter or drop-in center, or day shelter serving people experiencing homelessness.

Form submissions must be completed by the Executive Director of the shelter's managing organization or an authorized signer. Assessments at separate sites will require separate form submissions.

Process:
1. Interested organizations must submit a survey by April 17th at midnight.
2. MCH will review submissions and notify interested organizations by April 22nd. Assessments will be provided to qualified organizations on a first-come, first-served basis based on the funds available.
3. All assessments will be completed by a designated contractor, Sustainable Energy Savings, Inc. (SES). MCH will send information to SES, who will reach out to the site contact independently to schedule and complete the assessment.
4. Upon completing the assessment, SES will provide copies to the qualified organization and to MCH.
5. MCH will remit payment for the cost of the assessment directly to SES.
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Organization Name *
Office/Administrative Address *
Office/Administrative City *
Office/Administrative ZIP *
Office/Work Phone *
Executive Director Name *
Executive Director Email Address *
Site Information
Please fill out separate applications for separate sites. Sites must meet the definition of a congregate emergency shelter, day shelter, drop-in center, or street outreach program.
Name of Site *
Site Address *
Site City *
Site ZIP *
Site Contact Name *
Site Contact Phone *
Site Contact Email *
Which category does the site fall into under these definitions? *
Do people have to be experiencing homelessness in order to access your program? *
In addition to mitigating the transmission of COVID-19, are there other HVAC issues or concerns you are looking to improve at the site? (i.e. heating, mechanical, mold, airflow)  
Square Footage of Site *
Number of Common Spaces *
Number of Private Rooms *
Number of Congregate Spaces *
Number of Furnaces and/or Rooftop Air Handlers *
Do you need a certificate of insurance from the contractor, SES? If so, please note any insurance thresholds or information needed on the certificate.
Anything else we should know?
Confirmations
I understand that by sending in a request, I am not guaranteed an assessment, and that selection criteria are subject to change. *
Required
I understand that this program only provides assessments through the Minnesota Coalition for the Homeless selected/designated HVAC contractor, Sustainable Energy Savings Inc. of Minneapolis, and that a different contractor cannot be selected. *
Required
I understand that this assessment opportunity will not fund the cost of any recommendations from the HVAC assessment. *
Required
I understand that Minnesota Coalition for the Homeless will directly pay the contractor, and that no funding will pass through the applicant organization. MCH will only pay for the cost of the assessment with SES and no further work is authorized. *
Required
By typing my name in this box, I am providing a digital signature and confirming that I am an authorized signer for my organization. *
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