Clean Air for Schools Application Form

Clean Air for Schools - Application form

Thank you for applying to receive free HEPA portable air cleaners from the Colorado Department of Public Health and Environment’s (CDPHE) Clean Air for Schools program! This online form must be filled out by a school administrator or other school personnel. If you are a teacher, nurse, parent, student, or other stakeholder interested in the program, share this form with your school’s administrators.

If you are interested in the program but do not have the information required to fill out this form, fill out our interest form and a representative will reach out to you with more details.

Name(Required)

First Last

Phone(Required)

Email(Required)

Role(Required)

School district representative

School administrator

Teacher

School nurse

Other

Role (If Other):(Required)

How would you prefer to be contacted?(Required)

Phone

School name:(Required)

County(Required)

School Address(Required)

Street Address Address Line 2 City State ZIP Code

School District:(Required)

Type of School:(Required)

Public

Private

Charter

Tribal

Facility

Licensed childcare/daycare/preschool

In-home childcare/daycare/preschool

Other

School Code:

License #:(Required)

What grade level does your school serve?(Required)

Number of Students:(Required)

Number of Teachers and Staff:(Required)

If Type of School "Other"(Required)

Year classroom buildings were built and/or renovated?(Required)

Type of ventilation system that services the classrooms:

Natural Ventilation

Unit Ventilators

Central AC

Do Not Know

Select all that apply.

If the type of school is a daycare, how many rooms does the daycare have?(Required)

How many standard classrooms are in your school?(Required)

A standard classroom is between 500 and 1,100 square feet.

How many small classrooms are in your school?(Required)

A small classroom is approximately 500 square feet or less.

How many large classrooms are in your school?(Required)

A large classroom is bigger than 1,100 square feet.

How many teachers' lounges are in your school?(Required)

How many music/band/choir spaces are in your school?(Required)

A music/band/choir room is bigger than 1,500 square feet.

How many nurses’ office rooms are in your school? (Required)

Total Number of PACs:

Hidden

Total Number of Filters:

Hidden

Value

PLEASE scroll to the bottom and sign, then submit

Memorandum of Understanding: Colorado Clean Air for Schools Program Introduction and purpose The Clean Air for Schools program provides HEPA portable air cleaners (HEPA PACs) and necessary associated supplies at no cost to schools in Colorado in order to improve indoor air quality as a mitigation measure for COVID-19. HEPA PACs are tools that can reduce indoor air pollutants to improve air quality in buildings, which subsequently can reduce respiratory disease risk and improve health for occupants (e.g., students and teachers). This document serves as a Memorandum of Understanding (MOU) between the undersigned institution ( hereafter, “the School”) and Lohmiller dba Carrier West (hereafter, “Carrier West”), regarding the School’s participation in Clean Air for Schools. The purpose of this MOU is to clearly define the commitments of each entity (the School, Carrier West) for participation in Clean Air for Schools. The Clean Air for Schools program is supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $173,450,305 with 0% percentage financed with non-governmental sources. The contents of this document are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC, HHS, or the U.S. Government. Clean Air for Schools is provided through partnership with the Colorado Department of Public Health and Environment (CDPHE) Disease Control and Public Health Response Division’s Indoor Air Quality Program. Part I. Provision of PACs and Associated Supplies to the School

PACs and Supplies to be provided to the School:

Pursuant to this agreement, Carrier West will arrange for the shipment/delivery of the following equipment to the School:

0 HEPA Portable Air Cleaners, Model: RMAP-XL
0 Additional Filters for RMAP-XL: RMAPFIL-HXL
0 Extension/Surge Protector Cords: ESL-NP-PS4W
0 Floor Cord Covers (“cord trip protectors”): ESL-HP-CCP4B

Upon receipt, all items become the property and responsibility of the School. The School is responsible for inspecting the delivered items within three (3) business days of receipt to verify all items have been received and are in working order, and reporting any issues or missing items to Carrier West for rectification.

Delivery/Shipment details:

All items identified under Section I.A. will arrive in a single delivery/shipment. Delivery details are as follows:

Delivery of the PACs, extension/surge protector cords, floor cord covers, and additional filters will occur in May 2023 through July 2023. A Carrier West representative will email and call beforehand to coordinate delivery.
Location for delivery: , ,, ,

The School agrees to have a representative available on site at the designated date/time to receive the shipment and sign for the delivery.

Unboxing/Installation of HEPA PACs:

It is the responsibility of the School to unpack the delivered shipment, distribute the HEPA PACs, and associated supplies throughout the school for setup in the locations of intended use (e.g., classrooms and other areas as was determined in conjunction with Carrier West during enrollment), and set up/install the HEPA PACs.

Carrier West will provide installation and operation support videos to assist the School, which are available at: https://carriercolorado.com/clean-air-for-schools/
Carrier West will maintain a Customer Support Call Line, which the School can contact Monday through Friday (excluding standard holidays), 7 a.m. - 5 p.m. MT, to report any issues with HEPA PACs and associated supplies and receive guidance/support for installation and operation. The Call Line phone number is: 303-563-3082.
Carrier West will contact the School one (1) week after delivery date to ensure shipment was received in full and without any damaged products. Carrier West will rectify any reported issues with shipment.
Carrier West will contact the School two (2) weeks after delivery date to ensure installation and initial operation of HEPA PACs. Carrier West will advise on any operational issues reported to them.

Cost of HEPA PACs and Supplies: The approximate total value of all items is: $0. The School is not responsible for any cost associated with the initial provision of HEPA PACs and supplies identified herein. Operating the HEPA PACs within the schools requires that the HEPA PACs be connected to an electricity source (standard 120V/60Hz outlet). The Carrier RMAP-XL is Energy Star rated to have a clean air delivery rate of 9.4 CADR/W, anticipated to use 60 kilowatt hours (kWh) of energy per standard academic year (assuming the units are operated during standard school hours only when spaces are occupied). The School is responsible for any and all costs associated with the energy usage to operate the PACs within the schools. Part II. Use and Maintenance of HEPA PACs and Associated Supplies by the School

Responsibilities of the School

Upon receipt by the School, all items detailed in Part I, Section A are the property of the School. The School shall:

Be responsible for inspecting all items upon receipt to ensure the shipment was complete, all items were delivered in good working order, and that there are no issues with the shipment or items. The School is responsible for inspecting the delivered items within three (3) business days of receipt. If any issues are identified, the School shall work with Carrier West to resolve issues in a timely manner.
Use all items according to the intended use and manufacturer’s specifications for a minimum period of at least two (2) full academic years.
Be responsible for all utility costs for operation of the items.
Be responsible for all maintenance, repair, and upkeep of the items in order to keep items operational for at least two (2) full academic years. This includes replacing the HEPA filter within each HEPA PAC when indicated by the HEPA PAC or at a minimum of yearly.
Not sell, loan, or dispose of the items for at least two (2) full academic years.
Perform maintenance and service in accordance with the manufacturer’s user manual and warranty specifications.

Warranty information All HEPA PACs are protected by a manufacturer’s warranty, valid for one year from the date of delivery to the School (noted in Section I.B). Standard warranty terms can be found in the installation manual that is included with the units. To initiate a warranty claim, visit: https://www.lohmillercompany.com/warranty-center/. Warranty claim information that will be needed includes the unit serial number, your school name and CDE code, and school location/address.

Signatures: This MOU is agreed to and accepted by the following parties:
The School:
Name:

Title:
Phone:
Email:
Date:03/20/2023

Signature(Required)

Carrier West
Darryl Merkle
Strategic Accounts Manager
dmerkle@carrierwest.com
Ph: (720) 203-1705

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