Broward County BUSINESS APPLIANCE REBATE APPLICATION

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					Broward County
BUSINESS APPLIANCE REBATE
APPLICATION
                                 START HERE – PLEASE READ THIS FIRST
                                                        How to Apply
 1) Review Program Eligibility on page 3. See www.energystar.gov for list of eligible ENERGY STAR commercial-
      grade refrigerator and freezer models.
 2) Contact vendors for price quotes on the appliance you intend to purchase. You will need to provide the
      purchase price of the appliance during pre-registration.
 3) Pre-register at www.broward.org/gogreen or call 954-357-REB8 (954-357-7328), Monday through Friday,
      between 8:30 am to 5:00 pm, from September 7 to September 28, 2011, to obtain a Reservation Number.
      Reservations and rebates will be dispersed on a first-come, first-served basis.
 4) Complete a free Florida Power & Light (FPL) Business Energy Evaluation or call 1-877-748-4233 to schedule an
      evaluation with a FPL representative or online at www.FPL.com. You may need to register with FPL for online
      access.
 5) Purchase an eligible ENERGY STAR commercial-grade refrigerator or freezer on/after September 7, 2011.
      Then, recycle/ dispose of the old appliance according to federal/state/local laws and regulations; make sure
      the old appliance is not resold or put back into service.
 6) Complete and sign the application form and gather the required documentation to include in your application
      packet.
 7) Mail the application packet to the address below. The application packet must be postmarked no later than
      Friday, November 4, 2011 or your rebate reservation will be forfeited and made available to waiting list
      applicants.
                           Please allow 6-8 weeks after application deadline for the delivery of your
                                             rebate check from Broward County.

ONLY COMPLETE AND ACCURATE APPLICATIONS WILL BE PROCESSED
                                                                   Natural Resources Planning and Management Division

         SEND FORMS TO                                             ATTN: Energy Sense Appliance Rebate Program
                                                                   115 S. Andrews Ave., Suite 329H
                                                                   Fort Lauderdale, FL 33301
         Call 954-357-REB8 (954-357-7328) with questions or inquires.

1. APPLICANT INFORMATION (Must match information on pre-registration form)
Business Name                                    Owner/Principal First Name                  Last Name


Business Mailing Address                         City                                        Zip Code


Business Phone #                                 Cell Phone #                                Email Address

Reservation/Waiting List #                       NAICS Code OR Type of Business (describe)




                                                                                                                        1
Broward County
BUSINESS APPLIANCE REBATE
APPLICATION
 2. APPLIANCE INFORMATION
                  Eligible Appliance                                        Rebate Amount                              Check ONE box
 ENERGY STAR commercial-grade Refrigerator*             20% of appliance cost up to a maximum of $1,000
 ENERGY STAR commercial-grade Freezer*                  20% of appliance cost up to a maximum of $1,000

         Serial # (of new Appliance)                                      Manufacturer/Brand                  Model Number


         Purchase Price (without sales tax):                                                                   Age of OLD Appliance


                                                                                                              years

   *A list of eligible USEPA ENERGY STAR Qualified Products may be found at www.energystar.gov. Purchase of an ineligible product will
   result in disqualification for a rebate.


3. Additional Information (Please Check One)

A. My old appliance was disposed or recycled by/at:           Retailer         Landfill       Other, please describe _____________


B. Did the Rebate Program influence your decision to purchase an Energy Star appliance?                  No           Yes


C. My NEW refrigerator/freezer has a:            Solid Door          Glass Door


4. APPLICATION CHECK LIST (Include ALL items below with your COMPLETED application packet)

       Completed Application             Original Purchase Receipt       Photocopy of most recent FPL utility bill

       Photocopy of FPL Business Energy Evaluation (completed after April 30, 2011)

5. BUYER’S SIGNATURE
  By signing this form, I certify that the information provided on this rebate application and in its supporting documents
  is accurate, that I meet the eligibility requirements of the Broward County Business Appliance Rebate Program, and
  that I have read, understand, and agree to comply with the program terms and conditions. I affirm that the new
  appliance replaced an existing appliance which has been permanently taken out of service and been properly disposed.



  Required Signature                                                                              Date


                      Please retain a copy of the application packet for your records
                                                                                                                                         2
 BROWARD COUNTY
 BUSINESS APPLIANCE REBATE
 TERMS AND CONDITION
1. Program Eligibility                                            requested on the rebate application form,
   To qualify for a rebate, the applicant must meet the           including supporting documents. The purchaser
   following criteria:                                            must sign and date the application form.
    Must be a legitimate small to medium- sized business        Must pay sales tax on appliance purchased.
     physically located in Broward County with a valid
     Broward County address. Qualifying appliances must 2. Rebate Restrictions
     be purchased and installed for business use in           Limit one rebate per person and business.
     Broward County. Small to medium sized businesses         Rebates are limited to one appliance per rebate.
     are defined as using less than 500 KWD as displayed      Rebates are awarded on a first-come, first-served
     on Florida Power & Light utility bill, with one of the    basis.
     following allowable rate code classifications            By pre-registering for a rebate and receiving a
     designations: General Service Non-Demand (GS-1),          reservation confirmation, rebate funds are
     General Service Demand (GSD-1), General Service           reserved for the applicant.
     Non-Demand Time of Use (GST-1), or General Service       Rebates are not guaranteed and require full
     Demand Time of Use (GSDT-1). Applicant must               compliance of the governing rules to be issued. If
     provide proof of business location to include a copy of   each of the program requirements are not
     the business’ most recent Florida Power & Light utility   satisfied, the applicant gives up rights to the rebate
     bill with the same business name and address as on        and those rebate funds will no longer be available
     the application. Post Office Boxes are ineligible.        to the applicant. The rights to a rebate or a rebate
    Must purchase a new ENERGY STAR commercial                application may not be transferred or sold.
     refrigerator or freezer based on the current list of     Reservation Numbers expire if a valid and
     eligible USEPA ENERGY STAR Qualified Products found       complete submission of application packet is not
     at www.energystar.gov.                                    postmarked by November 4, 2011.
    Must replace an existing appliance of the same type.     Waiting list applicants will only receive rebates if
    Must dispose/recycle the existing appliance according     funds become available from unused reserved
     to federal/state/local laws and regulations. The          rebates or disqualified rebate applications.
     existing appliance must not be resold or put back into   Purchase of ineligible product will result in
     service. Recycling methods for existing appliance is      disqualification for a rebate.
     available at www.broward.org/gogreen and click           Original purchase receipt submitted with the
     REBATE PROGRAMS.                                          application must include: make and model of
    Must be approved through a preregistration program,       appliance; amount paid for appliance; date of
     which opens September 7, and closes September 28,         purchase; and retailer name where purchase was
     2011 or until all rebate funds are reserved.              made.
    Must make the purchase of eligible products during       Original purchase receipt must include a valid
     the rebate offer period on or after September 7,          model number for the applicable ENERGY STAR
     2011.                                                     Product.
    Must install the appliance at the business listed on     Based on purchase receipt, a maximum rebate will
     the rebate application form, prior to submittal of the    be awarded equal to but not greater than the
     rebate application.                                       amount requested on reservation form.
    Must mail a complete rebate application to the           Rebates will not be awarded for appliances
     address specified on the rebate application form by       purchased before the rebate offer period,
     November 4, 2011(postmarked) in one mailing.              September 7, 2011.
     Application packets must include all information

                                                                                                                   3
     BROWARD COUNTY
     BUSINESS APPLIANCE REBATE
      0
     TERMS & CONDITIONS                                          
                                                                 
      Rebates are subject to available funding. Due to           appliance offered for sale or purchased, (2) services
       grant requirements, all rebate monies and issues           provided by a retailer, installer, contractor, hauler, or
       must be expended/resolved by February 29, 2012.            recycler.
       Any unresolved issues after this date will be            This program was prepared as an account of work
       ineligible for rebates.                                    sponsored by an agency of the United States
      Purchase of products that are used, rebuilt, rented,       Government. Neither the United States Government
       leased, exchanged, won as a prize or purchased at          nor any agency thereof, nor any of their employees,
       auction or online auction are ineligible.                  nor any of their contractors, subcontractors or their
      Rebate values vary based on price paid for product         employess, makes any warranty, express or implied,
       less discounts, and does not include: sales tax;           or assumes any legal liability or responsibilty for the
       auxiliary equipment purchases; or installation and         accuracy, completeness, or third party’s use or the
       delivery/freight charges.                                  results of such of any information, apparatus,
                                                                  product, or process disclosed, or represents that its
3.   Public Records                                               use would not infringe privately owned rights.
     Under Florida law, information/documents submitted           Reference herein to any specific commerical product,
     by applicant will become public record and may be            process, or serivce by trade name, trademark,
     subject to public disclosure.                                manufacturer, or otherwise, does not necessarily
4.   Verification of Installation                                 constitute or imply its endorsement,
     Application/purchase may be subject to visual                recommendation, or favoring by the United States
     inspection/verification of installation by Broward           Government or any agency thereof or its contractors
     County. The applicant must provide Broward County, or        or subcontractors. The views and opinions of authors
     agents of, with access to the business listed on rebate      expressed herein do not necessarily state or reflect
     application form based upon reasonable written               those of the United States Government or any
     notification. The County may deny or seek the return of      agency thereof.
     payment to an applicant that refuses to provide the        Broward County is not responsible for: lost, late,
     County with access to the business to verify appliance       incomplete, damaged, misdirected, or postage due
     installation.                                                requests/mail; electronic transmission errors;
                                                                  technical, network, telephone equipment, electronic,
5.   Purchaser Compliance Responsibilities
                                                                  computer, hardware or software malfunctions;
     The applicant is responsible for compliance with all
                                                                  limitations of any kind; inaccurate transmissions of
     requirements of federal, state, county, and city
                                                                  or failure to receive rebate submission on account of
     governments. Tenants are responsible for obtaining the
                                                                  technical problems or traffic congestion on the
     property owner’s permission to install the purchased
                                                                  internet or at any website; or any combination
     appliance, if needed. Any fraudulent activities are a
                                                                  thereof.
     violation of criminal and civil laws; Broward County
     reserves the right to seek damages from rebate            8. Acknowledgement
     applicant to the fullest extent of the law.                  Funding for the Energy Sense program is made
                                                                  possible by an Energy Efficiency and Conservation
6.   Endorsement
                                                                  Block Grant through the American Recovery and
     Broward County does not endorse any particular
                                                                  Reinvestment Act.This material is based upon work
     appliance, retailer, manufacturer, installer, contractor,
                                                                  supported by the U.S. Department of Energy, Office
     hauler, or recycler that provides products or services
                                                                  of Energy Efficiency and Renewable Energy grant
     related to the Broward County Appliance Rebate
                                                                  agreement # DE-E000800 and the Florida Energy and
     Program.
                                                                  Climate Commission grant agreement # ARE010.
7.   Disclaimer of Warranty & Limitation of Liability
      Broward County makes no warranties, nor shall be
        liable for damages regarding/related to: (1) the

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